Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis

Hua, Xing; Zhang, Bohan; Zheng, Zhicheng; Fan, Houyou; Luo, Linfeng; Chen, Xiaosi; Duan, Jian; Zhou, Dongwei; Li, Meihua; Hong, Tao; Lu, Guohui

doi:10.1007/s00415-020-09765-9

Cited by 7 publications

(10 citation statements)

References 60 publications

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“…GPi-DBS is a valid option in the case of failed resection surgery [29]. Taken together, the previous literature indicates that the improvement rate of resection surgery is about 73-88% [4,6,7,[12][13][14]16], while that of DBS is about 54-76% [21][22][23][24][25][26][27]. However, while the former had better overall efficacy, DBS led to better results in terms of pain relief and long-term efficacy.…”

Section: Discussionmentioning

confidence: 98%

“…Another prospective, randomized, multicenter study showed that 3 months of GPi-DBS in 62 patients with cervical dystonia was more effective than sham stimulation in terms of symptom reduction [ 20 ]. Other authors have reported that DBS can improve the total TWSTRS score by about 54–76% [ 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. In our patient group, the mean improvement in the postoperative TWSTRS score was larger in the DBS versus DAM group (Z = −3.161, p = 0.002).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the prognostic factors related to DBS surgery outcome, Hua’s meta-analysis showed that the effect of DBS on ST was related to the age at surgery, such that patients who had a younger age of onset were more likely to have a good postoperative outcome. Further, there was no correlation between the surgery outcome and gender, medical history, or follow-up time [ 27 ]. However, our results showed no significant correlation between the age at surgery, gender, disease duration, and postoperative curative effect, although the prognosis was related to the length of the postoperative follow-up period.…”

Section: Discussionmentioning

confidence: 99%

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The Long-Term Efficacy, Prognostic Factors, Safety, and Hospitalization Costs Following Denervation and Myotomy of the Affected Muscles and Deep Brain Stimulation in 94 Patients with Spasmodic Torticollis

et al. 2022

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The surgical methods for treating spasmodic torticollis include the denervation and myotomy (DAM) of the affected muscles and deep brain stimulation (DBS). This study reports on the long-term efficacy, prognostic factors, safety, and hospitalization costs following these two procedures. We collected data from 94 patients with spasmodic torticollis, of whom 41 and 53 were treated with DAM and DBS, respectively, from June 2008 to December 2020 at the Chinese People’s Liberation Army General Hospital. We used the Tsui scale and the global outcome score of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) to evaluate the preoperative and postoperative clinical conditions in all patients. We also determined the costs of hospitalization, prognostic factors, and serious adverse events following the two surgical procedures. The mean follow-up time was 68.83 months (range = 13–116). Both resection surgery and DBS showed good results in terms of Tsui (Z = −5.103, p = 0.000; Z = −6.210, p = 0.000) and TWSTRS scores (t = 8.762, p = 0.000; Z = −6.308, p = 0.000). Compared with the DAM group, the preoperative (47.71, range 24–67.25) and postoperative (18.57, range 0–53) TWSTRS scores in the DBS group were significantly higher (Z = −3.161, p = 0.002). We found no correlation between prognostic factors and patient age, gender, or disease duration for either surgical procedure. However, prognostic factors were related to the length of the postoperative follow-up period in the DBS surgery group (Z = −2.068, p = 0.039; Z = −3.287, p = 0.001). The mean hospitalization cost in the DBS group was 6.85 times that found in the resection group (Z = −8.284, p = 0.000). The total complication rate was 4.26%. We found both resection surgery and DBS showed good results in the patients with spasmodic torticollis. Compared with DAM, DBS had a greater improvement in TWSTRS score; however, it was more expensive. Prognostic factors were related to the length of the postoperative follow-up period in patients who underwent DBS surgery.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Long-Term Efficacy, Prognostic Factors, Safety, and Hospitalization Costs Following Denervation and Myotomy of the Affected Muscles and Deep Brain Stimulation in 94 Patients with Spasmodic Torticollis

et al. 2022

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“…This situation necessitates a reliable preoperative outcome predictor to guide therapeutic decisions and select appropriate surgery candidates. So far, several clinical biomarkers have been proven to be associated with the prognosis of DBS surgery for craniocervical dystonia patients, such as preoperative severity of disease ( Wang et al, 2019a , Wang et al, 2019b ), age at surgery ( Hua et al, 2020 ), disease duration ( Isaias et al, 2008 ), and electrodes position ( Tian et al, 2021 , Yao et al, 2019 ). In addition, some neurophysiological parameters, such as the average firing rates within GPi ( Tian et al, 2021 ), the peak theta oscillatory activity within GPi ( Neumann et al, 2017 ), and the volume of tissue activated ( Reich et al, 2019 , Soares et al, 2021 ), have been endowed with the ability to predict the efficacy of DBS surgery.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar gray matter alterations predict deep brain stimulation outcomes in Meige syndrome

Liu

Mao

Cui

et al. 2023

NeuroImage: Clinical

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“…STN-DBS shows stronger benefits with regard to pain relief that can be attributed to its faster action in correcting forced postures. Earlier studies indicate that STN-DBS is beneficial in this regard for Parkinson's disease [33] but not for dystonia [34,35]. However, recently, the involvement of the substantia nigra pars reticulata -STN GABAergic pathway in pain alleviation was revealed [36], indicating the potential of STN stimulation.…”

Section: Stn-dbs Can Also Facilitate Emotional Well-being In Patients...mentioning

confidence: 99%

Globus pallidus internus versus subthalamic nucleus deep brain stimulation for isolated dystonia: A 3‐year follow‐up

Lin

Shu

Zhang

et al. 2023

Euro J of Neurology

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Background and purpose Bilateral deep brain stimulation (DBS) surgery targeting the globus pallidus internus (GPi) or the subthalamic nucleus (STN) is widely used in medication‐refractory dystonia. However, evidence regarding target selection considering various symptoms remains limited. This study aimed to compare the effectiveness of these two targets in patients with isolated dystonia. Methods This retrospective study evaluated 71 consecutive patients (GPi‐DBS group, n = 32; STN‐DBS group, n = 39) with isolated dystonia. Burke–Fahn–Marsden Dystonia Rating Scale scores and quality of life were evaluated preoperatively and at 1, 6, 12, and 36 months postoperatively. Cognition and mental status were assessed preoperatively and at 36 months postoperatively. Results Targeting the STN (STN‐DBS) yielded effects within 1 month (65% vs. 44%; p = 0.0076) and was superior at 1 year (70% vs. 51%; p = 0.0112) and 3 years (74% vs. 59%; p = 0.0138). For individual symptoms, STN‐DBS was preferable for eye involvement (81% vs. 56%; p = 0.0255), whereas targeting the GPi (GPi‐DBS) was better for axis symptoms, especially for the trunk (82% vs. 94%; p = 0.015). STN‐DBS was also favorable for generalized dystonia at 36‐month follow‐up (p = 0.04) and required less electrical energy (p < 0.0001). Disability, quality of life, and depression and anxiety measures were also improved. Neither target influenced cognition. Conclusions We demonstrated that the GPi and STN are safe and effective targets for isolated dystonia. The STN has the benefits of fast action and low battery consumption, and is superior for ocular dystonia and generalized dystonia, while the GPi is better for trunk involvement. These findings may offer guidance for future DBS target selection for different types of dystonia.

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Predictive factors of outcome in cervical dystonia following deep brain stimulation: an individual patient data meta-analysis

Cited by 7 publications

References 60 publications

The Long-Term Efficacy, Prognostic Factors, Safety, and Hospitalization Costs Following Denervation and Myotomy of the Affected Muscles and Deep Brain Stimulation in 94 Patients with Spasmodic Torticollis

The Long-Term Efficacy, Prognostic Factors, Safety, and Hospitalization Costs Following Denervation and Myotomy of the Affected Muscles and Deep Brain Stimulation in 94 Patients with Spasmodic Torticollis

Cerebellar gray matter alterations predict deep brain stimulation outcomes in Meige syndrome

Globus pallidus internus versus subthalamic nucleus deep brain stimulation for isolated dystonia: A 3‐year follow‐up

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