Deep brain stimulation in post‐traumatic dystonia: A case series study

Abstract

AimsDeep brain stimulation (DBS) has been proposed as an effective treatment for drug‐intolerant isolated dystonia, but whether it is also efficacious for posttraumatic dystonia (PTD) is unknown. Reports are few in number and have reached controversial conclusions regarding the efficacy of DBS for PTD treatment. Here, we report a case series of five PTD patients with improved clinical benefit following DBS treatment.MethodsFive patients with disabling PTD underwent DBS therapy. The clinical outcomes were assessed with the Burke–Fahn–Marsden dystonia rating scale (BFMDRS) at baseline and the last follow‐up visit (at more than 12 months).ResultsPatients 1 and 3 received unilateral globus pallidus internus (GPi) DBS for contralateral dystonia. The subthalamic nucleus (STN) was chosen as target for patients 2 and 4, due to a lesion located in the globus pallidus. Patient 5 had an electrode in the ventral intermediate nucleus (VIM) for treating predominant tremor of left upper extremity, with unexpected improvement of focal hand dystonia. The scores of BFMDRS movement exhibited favorable improvement in all five patients at the last follow‐up, ranging from 52.4% to 78.6%.ConclusionsDeep brain stimulation may be an effective and safe treatment for medically refractory PTD, but this needs to be confirmed by further studies.

Subthalamic Nucleus Deep Brain Stimulation in Post-Infarct Dystonia

“…Shorter disease duration correlated positively with larger DBS treatment efficacy, with a more persistent improvement and larger treatment potential with STN stimulation. Similar experience has been described by others [39-53].…”

“…Shorter disease duration correlated positively with larger DBS treatment efficacy, with a more persistent improvement and larger treatment potential with STN stimulation. Similar experience has been described by others [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53]. STN DBS has also been successfully used in the management of Meige syndrome with motor score improvements in the range of 42.1-74% [54][55][56][57] and in tardive dystonia with improvements of 88-100% at up to 12-year follow-up periods [41,58,59].…”

“…STN DBS has been utilized in selected cases of combined dystonia (dystonia with Parkinson's disease or essential tremor) with good results [60][61][62]. Specifically, in hemidystonias, STN DBS has been used successfully as described in 3 case reports with a 62.5-91% improvement when compared to baseline scores [39,53,63].…”

Successful treatment of focal hand dystonia after cervical whiplash injury by thalamotomy

“…[ 8 ] The effectiveness of Vim thalamotomy has also been previously reported. [ 11 , 12 ] Moreover, recurrence after Vo thalamotomy has been reported to occur due to insufficient or incorrect coagulation over the entire Vo nucleus of the thalamus. [ 7 ] In our case, the thalamotomy lesion after the first operation did not cover a part of the Vo nucleus [ Figure 2 ].…”

Subthalamic Nucleus Deep Brain Stimulation Lessens Acquired Dystonia: Report of Two Patients and Systematic Review of Published Cases

“…Eight studies were retained after the selection process (Fig. 4), reporting 17 cases between 2006 and 2019 [10, [17][18][19][20][21][22][23]. Table 2 summarizes 19 reported cases (12 men and 7 women), including 2 patients reported herein.…”