title: Long-Term Clinical Outcome of Internal Globus Pallidus Deep Brain Stimulation for Dystonia.
abstract: BACKGROUND
  GPi (Internal globus pallidus) DBS (deep brain stimulation) is recognized as a safe, reliable, reversible and adjustable treatment in patients with medically refractory dystonia.
  
  
  OBJECTIVE
  This report describes the long-term clinical outcome of 36 patients implanted with GPi DBS at the Neurosurgery Department of Seoul National University Hospital.
  
  
  METHODS
  Nine patients with a known genetic cause, 12 patients with acquired dystonia, and 15 patients with isolated dystonia without a known genetic cause were included. When categorized by phenomenology, 29 patients had generalized, 5 patients had segmental, and 2 patients had multifocal dystonia. Patients were assessed preoperatively and at defined follow-up examinations postoperatively, using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS) for movement and functional disability assessment. The mean follow-up duration was 47 months (range, 12-84).
  
  
  RESULTS
  The mean movement scores significantly decreased from 44.88 points preoperatively to 26.45 points at 60-month follow up (N = 19, P = 0.006). The mean disability score was also decreased over time, from 11.54 points preoperatively to 8.26 points at 60-month follow up, despite no statistical significance (N = 19, P = 0.073). When analyzed the movement and disability improvement rates at 12-month follow up point, no significant difference was noted according to etiology, disease duration, age at surgery, age of onset, and phenomenology. However, the patients with DYT-1 dystonia and isolated dystonia without a known genetic cause showed marked improvement.
  
  
  CONCLUSIONS
  GPi DBS is a safe and efficient therapeutic method for treatment of dystonia patients to improve both movement and disability. However, this study has some limitations caused by the retrospective design with small sample size in a single-center.
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hye Ran
authors.initials: HR
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jae Meen
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Neurology, Myongji Hospital, Gyeonggi, Republic of Korea.
authors.forename: Gwanhee
authors.initials: G
authors.lastname: Ehm
authors.affiliation: Department of Neurology, Ulsan University Hospital, Ulsan, Republic of Korea.
authors.forename: Hui-Jun
authors.initials: HJ
authors.lastname: Yang
authors.affiliation: Medical Device Development Center, Osong Medical Innovation Foundation, Chungcheong, Republic of Korea.
authors.forename: In Ho
authors.initials: IH
authors.lastname: Song
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Yong Hoon
authors.initials: YH
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Mi-Ryoung
authors.initials: MR
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Keyoung Ran
authors.initials: KR
authors.lastname: Kim
authors.affiliation: Department of Neurology, Eulji General Hospital, Seoul, Republic of Korea.
authors.forename: Woong-Woo
authors.initials: WW
authors.lastname: Lee
authors.affiliation: Department of Neurology, Hallym University Sacred Heart Hospital, Gyeonggi, Republic of Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Daejeon Woori Hospital, Gyeonggi, Republic of Korea.
authors.forename: Jae Ha
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Chae Won
authors.initials: CW
authors.lastname: Shin
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Han-Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Medical Imaging Laboratory, and CyberMed, Inc., Seoul, Republic of Korea.
authors.forename: Cheolyoung
authors.initials: C
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.|Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Kim
authors.affiliation: Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.|Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Jeon
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.|Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Paek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D046690:Deep Brain Stimulation / Q000009:adverse effects; D004185:Disability Evaluation; D004421:Dystonia / Q000503:physiopathology* / Q000601:surgery; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D005917:Globus Pallidus / Q000503:physiopathology*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult