Deep brain stimulation in dystonia

Abstract

Renewed interest in stereotaxy for dystonia followed the introduction of deep brain stimulation (DBS) in Parkinson's disease and essential tremor in the 1990s. DBS evolved from ablative surgery, which was applied with varying results in the 1950s in patients with movement disorders such as Parkinson's disease, essential tremor and dystonia. The present review summarizes the current knowledge on clinical aspects of DBS in dystonia (Dec. 2002). Excellent results have been achieved in dystonic patients carrying a mutation in the DYT1 gene with improvements up to 90 %. Similar results may also be obtained in patients with idiopathic generalized dystonia, myoclonus-dystonia syndrome, and tardive dystonia. Substantial improvement has been observed in patients with focal dystonia (for instance cervical dystonia). Patients with secondary dystonia often display a lesser and more variable degree of improvement. Long-term studies are warranted to assess both motor and neuropsychological sequelae of DBS in dystonia. Furthermore, the optimal target for different dystonic disorders remains to be determined, although the globus pallidus internus has currently emerged as the most promising target for dystonia.

Challenging neurological symptoms in paediatric palliative care: An approach to symptom evaluation and management in children with neurological impairment

“…Neurosurgical approaches, including deep-brain stimulation of the globus pallidum internum, are well established for treatment of dystonia; however, these would be considered to be extreme and invasive measures in a palliative setting (19,20,22).…”

Genetics and Pathophysiology of Neurodegeneration with Brain Iron Accumulation (NBIA)

“…The most effective practice appears to be deep brain stimulation of the posteroventral part of globus pallidus internus (DBS GPi). However, compared to primary generalized dystonias with most studies showing long-lasting 21-95% improvement in the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), the outcomes of DBS GPi in NBIA are more variable and at large less favourable [84][85][86]. In the largest series of 23 PKAN patients, at follow-up 9-15 months postoperatively, dystonia severity assessed by the BFMDRS had improved by 20% or more in two thirds of patients [87].…”

A Simple Stereotactic Method for Frameless Deep Brain Stimulation

“…High-frequency stimulation of the subthalamic nucleus, the globus pallidus internus and the thalamus using DBS leads is a widely used treatment to control Parkinson's disease, dystonia and tremor [5][6][7][8] . However, its effectiveness is dependent on precise placement of the contact in the functional target and its fixation to the skull to prevent lead migration and displacement.…”