title: Subthalamic nucleus deep brain stimulation in isolated dystonia: A 3-year follow-up study.
abstract: OBJECTIVE
  To report long-term safety and efficacy outcomes of a large cohort of patients with medically refractory isolated dystonia treated with subthalamic nucleus (STN) deep brain stimulation (DBS).
  
  
  METHODS
  Twenty patients (12 male, 8 female; mean age 49 ± 16.3 years) with medically refractory isolated dystonia were studied (14 were followed for 36 months). The primary endpoints were change in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor score and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score at 36 months compared to preoperative baseline. Multiple secondary outcomes were also assessed (ClinicalTrials.gov NCT00773604).
  
  
  RESULTS
  Eighteen of 20 patients showed improvement 12 months after STN DBS with sustained benefit persisting for 3 years (n = 14). At 36 months, BFMDRS motor scores improved 70.4% from a mean 17.9 ± 8.5 to 5.3 ± 5.6 (p = 0.0002) and total TWSTRS scores improved 66.6% from a mean 41.0 ± 18.9 to 13.7 ± 17.9 (p = 0.0002). Improvement at 36 months was equivalent to that seen at 6 months. Disability and quality of life measures were also improved. Three hardware-related and 24 stimulation-related nonserious adverse events occurred between years 1 and 3 (including 4 patients with dyskinesia).
  
  
  CONCLUSIONS
  This study offers support for long-term tolerability and sustained effectiveness of STN DBS in the treatment of severe forms of isolated dystonia.
  
  
  METHODS
  This study provides Class IV evidence that STN DBS decreases long-term dystonia severity in patients with medically refractory isolated dystonia.
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA. jill.ostrem@ucsf.edu.
authors.forename: Jill L
authors.initials: JL
authors.lastname: Ostrem
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Marta
authors.initials: M
authors.lastname: San Luciano
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Dodenhoff
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ziman
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Leslie C
authors.initials: LC
authors.lastname: Markun
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Racine
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Coralie
authors.initials: C
authors.lastname: de Hemptinne
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Volz
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Heath
authors.affiliation: From the Department of Neurology, Movement Disorders and Neuromodulation Center (J.L.O., M.S.L., K.A.D., N.Z., L.C.M., M.M.V.), and Department of Neurological Surgery (C.A.R., C.d.H., P.A.S.), University of California, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., L.C.M., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, CA.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Starr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000379:methods*; D004421:Dystonia / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D020531:Subthalamic Nucleus / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult