Deep brain stimulation for dystonia: outcome at long-term follow-up

• Published in: Journal of neurology Vol. 255; no. 6; pp. 881 - 884
• Main Authors: Loher, T. J., Capelle, H.-H., Kaelin-Lang, A., Weber, S., Weigel, R., Burgunder, J. M., Krauss, J. K.
• Format: Journal Article
• Language: English
• Published: Darmstadt Steinkopff-Verlag 01-06-2008; Springer; Springer Nature B.V
• Subjects: Adult; Biological and medical sciences; Brain - physiopathology; Brain - surgery; Deep brain stimulation; Deep Brain Stimulation - methods; Deep Brain Stimulation - standards; Deep Brain Stimulation - statistics & numerical data; Diseases of striated muscles. Neuromuscular diseases; Dystonia; Dystonia - physiopathology; Dystonia - therapy; Dystonic Disorders - physiopathology; Dystonic Disorders - therapy; Female; Follow-Up Studies; Globus Pallidus - physiology; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Meige Syndrome - physiopathology; Meige Syndrome - therapy; Middle Aged; Neural Pathways - physiology; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Original Communication; Pacemaker, Artificial; Patients; Surgery; Thalamus - physiology; Time; Torticollis - physiopathology; Torticollis - therapy; Treatment Outcome; Minneapolis Minnesota; United States > US; Switzerland; Germany; dystonia; long-term follow-up; deep brain stimulation; Striated muscle disease; Nervous system diseases; Prognosis; Deep brain stimulation; Central nervous system disease; Dystonia; Neurological disorder; Long term; Involuntary movement; Cerebral disorder; Extrapyramidal syndrome
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-008-0798-6

Objective
Deep brain stimulation (DBS) has emerged as a useful therapeutic option for patients with insufficient benefit from conservative treatment.
Methods
Nine patients with chronic DBS who suffered from cervical dystonia (4), generalized dystonia (2), hemidystonia (1), paroxysmal dystonia (1) and Meige syndrome (1) were available for formal follow-up at three years postoperatively, and beyond up to 10 years. All patients had undergone pallidal stimulation except one patient with paroxysmal dystonia who underwent thalamic stimulation.
Results
Maintained improvement was seen in all patients with pallidal stimulation up to 10 years after surgery except in one patient who had a relative loss of benefit in dystonia ratings but continued to have improved disability scores. After nine years of chronic thalamic stimulation there was a mild loss of efficacy which was regained when the target was changed to the pallidum in the patient with paroxysmal dystonia. There were no major complications related to surgery or to chronic stimulation. Pacemakers had to be replaced within 1.5 to 2 years, in general.
Conclusion
DBS maintains marked long-term symptomatic and functional improvement in the majority of patients with dystonia.