Pallidal or Subthalamic Deep Brain Stimulation for the Generalized Dystonia Treatment

Abstract

One of the most effective treatments of medically refractory generalized dystonia (GD) is pallidal deep brain stimulation (GPi DBS). For selected group of GD patients’ subthalamic deep brain stimulation (STN DBS) might be similarly effective. The authors present a group of patients diagnosed with GD, treated with GPi or STN DBS. Materials and methods: Between 2005 and 2009 eleven female and eight male patients with diagnosed GD were treated with GPi DBS or STN DBS. Mean age at implantation was 26 ± 6. Two patients were diagnosed with DYT-1 mutation. Seven patients were diagnosed with PANK-2 mutation. One patient with previous bilateral pallidotomies and six patients with diagnosed PANK-2 mutation were qualified to STN DBS. Rest of the group was qualified to GPi DBS. Clinical status of the patients was evaluated with a package of dystonia scales. The follow-up evaluation was conducted 60 months after implantation. Results: The patients reported subjective improvement following surgery that was confirmed with tailored scales. Mean improvement was evaluated with Global Dystonia Scale to 48%. More significant improvement was reported in the GPi group than in the STN group (51% vs. 38%) The best results were achieved in the DYT-1 group (89%). Conclusion: Although analyzed group is not large, the authors state that deep brain stimulation is effective and safe method of GD treatment. Decision which anatomical target is optimal should be undertaken individually depending on clinical history, phenotype and etiology of GD.