Abstract
BackgroundGPi (Internal globus pallidus) DBS (deep brain stimulation) is recognized as a safe, reliable, reversible and adjustable treatment in patients with medically refractory dystonia.ObjectivesThis report describes the long-term clinical outcome of 36 patients implanted with GPi DBS at the Neurosurgery Department of Seoul National University Hospital.MethodsNine patients with a known genetic cause, 12 patients with acquired dystonia, and 15 patients with isolated dystonia without a known genetic cause were included. When categorized by phenomenology, 29 patients had generalized, 5 patients had segmental, and 2 patients had multifocal dystonia. Patients were assessed preoperatively and at defined follow-up examinations postoperatively, using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS) for movement and functional disability assessment. The mean follow-up duration was 47 months (range, 12–84)ResultsThe mean movement scores significantly decreased from 44.88 points preoperatively to 26.45 points at 60-month follow up (N = 19, P = 0.006). The mean disability score was also decreased over time, from 11.54 points preoperatively to 8.26 points at 60-month follow up, despite no statistical significance (N = 19, P = 0.073). When analyzed the movement and disability improvement rates at 12-month follow up point, no significant difference was noted according to etiology, disease duration, age at surgery, age of onset, and phenomenology. However, the patients with DYT-1 dystonia and isolated dystonia without a known genetic cause showed marked improvement.ConclusionsGPi DBS is a safe and efficient therapeutic method for treatment of dystonia patients to improve both movement and disability. However, this study has some limitations caused by the retrospective design with small sample size in a single-center.
Highlights
In 2013, an international panel of experts defined dystonia as sustained or intermittent muscle contractions usually causing twisting and repetitive movement or abnormal posture [1,2,3]
This report describes the long-term clinical outcome of 36 patients implanted with GPi DBS at the Neurosurgery Department of Seoul National University Hospital
Dystonia can be classified according to the involved body distribution: focal, segmental, multifocal, generalized, and hemidystonia, or according to the etiology: inherited dystonia of proven genetic origin, acquired dystonia with a known specific cause, and isolated dystonia without a known specific cause
Summary
In 2013, an international panel of experts defined dystonia as sustained or intermittent muscle contractions usually causing twisting and repetitive movement or abnormal posture [1,2,3]. It is one of the most prevalent forms of movement disorder [3]. Oral medications and botulinum toxin injections have been the mainstays of treatment for some time, they are not sufficiently effective in some patients. GPi (Internal globus pallidus) DBS (deep brain stimulation) is recognized as a safe, reliable, reversible and adjustable treatment in patients with medically refractory dystonia.
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