Deep brain stimulation versus pallidotomy for status dystonicus: a single-center case series

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>First-line pharmacological therapies have shown limited efficacy in status dystonicus (SD), while surgery is increasingly reported as remediable in refractory cases. In this context, there is no evidence regarding which neurosurgical approach is the safest and most effective. The aim of this study was to assess the clinical outcomes and surgery-related complications of globus pallidus internus deep brain stimulation (GPi DBS) and pallidotomy for the treatment of drug-resistant SD.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors reviewed the records of patients with drug-resistant SD who had undergone GPi DBS or pallidotomy at their institution between 2003 and 2017. The severity of the dystonia was evaluated using the Barry-Albright Dystonia (BAD) Scale. Surgical procedures were performed bilaterally in all cases.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Fourteen patients were eligible for inclusion in the study. After surgery, the mean follow-up was 40.6 ± 30 months. DBS ended the dystonic storm in 87.5% of cases (7/8), while pallidotomy had a success rate of 83.3% (5/6). No significant differences were observed between the two techniques in terms of failure rates (risk difference DBS vs pallidotomy −0.03, 95% CI −0.36 to 0.30), SD mean resolution time (DBS 34.8 ± 19 days, pallidotomy 21.8 ± 20.2 days, p &gt; 0.05), or BAD scores at each postoperative follow-up (p &gt; 0.05). The long-term hardware complication rate after DBS was 37.5%, whereas no surgery-related complications were noted following pallidotomy.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The study data suggest that DBS and pallidotomy are equally safe and effective therapies for drug-resistant SD. The choice between the two techniques should be tailored on a case-by-case basis, depending on factors such as the etiology and evolution pattern of the underlying dystonia and the clinical conditions at the moment of SD onset. Given the limitation of the low statistical power of this study, further multicentric investigations are needed to confirm its findings.</jats:p></jats:sec>

The Efficacy and Predictors of Using GPi-DBS to Treat Early-Onset Dystonia: An Individual Patient Analysis

“…Compared to pallidotomy, the complications of DBS surgery involve the hardware [ 42 ]. Most of the complications occurred after a long follow-up period.…”

Bilateral Pallidotomy for Dystonia: A Systematic Review

“…However, due to scarcity of literature, non‐English papers were also assessed. Finally, 33 papers met our inclusion criteria and were included in this review 15,17‐48 . The reasons to exclude the other 133 articles were the following: congress abstracts (n = 37), described no patients (n = 25), full text not available (n = 18), unilateral pallidotomy (n = 15), Parkinson's disease (n = 12), no (motor) outcomes (n = 9), patients described before (n = 7), thalamotomy or other lesions (n = 6), no dystonia patients (n = 2), and DBS only (n = 2) ( FIGURE S1).…”

Leksell’s Posteroventral Pallidotomy 1992–2022: Quo Vadis?

“…PVP seems thus to be reported more and more in single cases or small case series, to treat dystonic storm [43, 44], including in pediatric patients [45], or other refractory conditions beyond the classical generalized or cervical dystonia or PD, such as embouchure dystonia [40] camptocormia [41], abdominal dystonia [46], hemichorea-ballism [47], or Meige syndrome [48]. Recently, PVP has even shown beneficial effect on the postherpetic neuralgic pain of a patient who had received a pallidotomy primarily for PD [49].…”