Deep Brain Stimulation for Dystonia

Abstract

Deep brain stimulation (DBS) of the globus pallidum interna (GPi) is an established treatment for generalized and segmental dystonia. It works not only in primary dystonia but also in secondary dystonias such as tardive dystonia and dystonias in some congenital metabolic disorders. It has been shown that the shorter the disease duration is, the more favorable outcome is anticipated. GPi DBS should be considered before skeletal deformity and contracture develop. The role of the subthalamic and thalamic targets of DBS is not studied extensively, though there are data suggesting these targets can be used for certain types of dystonias. Risk of DBS surgery itself is minimal, but hardware-related problems such as rejection and infection may often occur even long time after operation. Although the treatment of dystonia has developed dramatically over the past 10 years, there are still many unsolved problems. For example, there is no unanimous agreement about optimal stimulation parameters, no scientific data are available if the ordinary GPi target is the best place in GPi; what the actual role of subthalamic nucleus DBS for dystonia is, how to reduce hardware-related complications, is DBS really better than ablative surgery like pallidotomy, and so on.