Abstract
Objective: Evaluation of effectiveness and safety of multimodal stereotactic procedures (lesioning and deep brain stimulation (DBS)) and multifocal (globus pallidus pars interna (GPi) and subthalamic nucleus (STN)) treatment of generalized dystonia (GD).Background: Thalamotomy and pallidotomy are the primary stereotactic methods of GD treatment. DBS is a surgical method of choice for various movement disorders treatment that include GD. Multimodal and multifocal DBS was involved in the movement disorders treatment to achieve better results, but no analysis has been conducted yet.Methods: Seven GD patients with history of bilateral GPi DBS or thalamotomy or pallidotomy were qualified for further surgical treatment. All of them demonstrated significant improvement that vanished few years after surgery. Five of them, who underwent lesioning in the past were qualified for DBS: GPi (3 patients) and STN (2 patient). Two patients, who underwent GPi stimulation in past were qualified for multifocal stimulation- additional STN DBS.Results: Multimodal and multifocal DBS have caused sustained improvement in dystonic movement (measured with GDS) that lasted in two to five years follow-up. No surgical or stimulation related complications were reported.Conclusions: Multimodal: lesioning and DBS and combined, multifocal GPi and STN DBS might and should be considered when dystonic symptoms aggravate over time. Objective: Evaluation of effectiveness and safety of multimodal stereotactic procedures (lesioning and deep brain stimulation (DBS)) and multifocal (globus pallidus pars interna (GPi) and subthalamic nucleus (STN)) treatment of generalized dystonia (GD). Background: Thalamotomy and pallidotomy are the primary stereotactic methods of GD treatment. DBS is a surgical method of choice for various movement disorders treatment that include GD. Multimodal and multifocal DBS was involved in the movement disorders treatment to achieve better results, but no analysis has been conducted yet. Methods: Seven GD patients with history of bilateral GPi DBS or thalamotomy or pallidotomy were qualified for further surgical treatment. All of them demonstrated significant improvement that vanished few years after surgery. Five of them, who underwent lesioning in the past were qualified for DBS: GPi (3 patients) and STN (2 patient). Two patients, who underwent GPi stimulation in past were qualified for multifocal stimulation- additional STN DBS. Results: Multimodal and multifocal DBS have caused sustained improvement in dystonic movement (measured with GDS) that lasted in two to five years follow-up. No surgical or stimulation related complications were reported. Conclusions: Multimodal: lesioning and DBS and combined, multifocal GPi and STN DBS might and should be considered when dystonic symptoms aggravate over time.
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