Deep brain stimulation for dystonia
Journal of Neurology, Neurosurgery and Psychiatry
The few controlled studies that have been carried out have shown that bilateral internal globus pallidum stimulation is a safe and long-term effective treatment for hyperkinetic disorders. However, most recent published data on deep brain stimulation (DBS) for dystonia, applied to different targets and patients, are still mainly from uncontrolled case reports (especially for secondary dystonia). This precludes clear determination of the efficacy of this procedure and the choice of the 'good'
... get for the 'good' patient. We performed a literature analysis on DBS for dystonia according to the expected outcome. We separated those with good evidence of favourable outcome from those with less predictable outcome. In the former group, we review the main results for primary dystonia (generalised/focal) and highlight recent data on myoclonus-dystonia and tardive dystonia (as they share, with primary dystonia, a marked beneficial effect from pallidal stimulation with good risk/ benefit ratio). In the latter group, poor or variable results have been obtained for secondary dystonia (with a focus on heredodegenerative and metabolic disorders). From this overview, the main results and limits for each subgroup of patients that may help in the selection of dystonic patients who will benefit from DBS are discussed. LITERATURE ANALYSIS ACCORDING TO THE EXPECTED OUTCOME Dystonia with good evidence of favourable outcome This group is heterogeneous and includes primary dystonia, myoclonus-dystonia (dystonia-plus syndrome category) and tardive dystonia (secondary dystonia category). Improvements of 50-60% were generally observed, with some patients experiencing as much as a 90% reduction in severity and Editor's choice Scan to access more free content Vidailhet M, et al.