Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis

Abstract

BackgroundThere is limited information on optimization of symptomatic management of cervical dystonia (CD) after implantation of pallidal deep brain stimulation (DBS).ObjectivesTo describe the long-term, “real-world” management of CD patients after DBS implantation and the role of reintroduction of pharmacologic and botulinum toxin (BoNT) therapy.MethodsA retrospective analysis of patients with focal cervical or segmental craniocervical dystonia implanted with DBS was conducted.ResultsNine patients were identified with a mean follow-up of 41.7 ± 15.7 months. All patients continued adjuvant oral medication(s) to optimize symptom control post-operatively. Three stopped BoNT and four reduced BoNT dose by an average of 22%. All patients remained on at least one medication used to treat dystonia post-operatively.ConclusionOptimal symptom control was achieved with DBS combined with either BoNT and/or medication. We suggest utilization of adjuvant therapies such as BoNT and/or medications if DBS monotherapy does not achieve optimal symptom control.

New developments in diagnostics and treatment of adult-onset focal dystonia

“…Continuing prior/additional therapies can be necessary. A small size long-term management study in cervical dystonia patients showed optimal symptom control with at least one form of adjuvant therapy (BoNT and/or oral pharmacotherapeutics) [53]. Continuing adjuvant therapies should be considered in those patients that have not yet achieved satisfactory improvement of symptoms by solitary DBS treatment.…”

Botulinum Toxin and Deep Brain Stimulation in Dystonia

“…In the literature, there are few studies that have evaluated the usage of botulinum toxin before and after DBS surgery in dystonic patients [ 11 , 12 , 13 ]. One retrospective study from 2022 analyzed nine patients with cervical dystonia and found a reduction in BoNT dose after DBS in four patients, with an average of 22% dose reduction [ 11 ].…”

“…In the literature, there are few studies that have evaluated the usage of botulinum toxin before and after DBS surgery in dystonic patients [ 11 , 12 , 13 ]. One retrospective study from 2022 analyzed nine patients with cervical dystonia and found a reduction in BoNT dose after DBS in four patients, with an average of 22% dose reduction [ 11 ]. Another study demonstrated that in a case series of three patients with generalized dystonia who underwent DBS surgery, preoperative BoNT dosages and those after the procedure were not different [ 12 ].…”