Abstract
Introduction: Dystonia is a movement disorder substantially affecting the quality of life. Botulinum Neurotoxin (BoNT) is used intramuscularly as a treatment for dystonia; however, not all dystonia patients respond to this treatment. Deep brain stimulation (DBS) is an established treatment for Parkinson’s disease (PD) and essential tremor, but it can help in dystonia as well. Objectives: We studied a total of 67 dystonia patients who were treated with DBS over a period of 7 years to find out the long-term efficacy of DBS in those patients. First, we calculated patient improvement in post-surgery follow-up programs using the Global Dystonia Severity scale (GDS) and Burke–Fahn–Marsden dystonia rating scale (BFMDRS). Secondly, we analyzed the scales scores to see if there was any statistical significance. Methods: In our study we analyzed patients with ages from 38 to 78 years with dystonia who underwent DBS surgery between January 2014 and December 2020 in four different centers (India, Kuwait, Egypt, and Turkey). The motor response to DBS surgery was retrospectively measured for each patient during every follow-up visit using the GDS and the BFMDRS scales. Results: Five to 7 years post-DBS, the mean reduction in the GDS score was 30 ± 1.0 and for the BFMDRS score 26 ± 1.0. The longitudinal change in scores at 12 and 24 months post-op was also significant with mean reductions in GDS and BFMDRS scores of 68 ± 1.0 and 56 ± 1.0, respectively. The p-values were <0.05 for our post-DBS dystonia patients. Conclusions: This study illustrates DBS is an established, effective treatment option for patients with different dystonias, such as generalized, cervical, and various brain pathology-induced dystonias. Although symptoms are not completely eliminated, continuous improvements are noticed throughout the post-stimulation time frame.
Highlights
Dystonia is a movement disorder substantially affecting the quality of life
The Global Dystonia Severity scale (GDS) p-value was 0.017 after 84 months post-Deep brain stimulation (DBS) stimulation, which showed improvement of more than 86% for those patients, and the Burke–Fahn–Marsden dystonia rating scale (BFMDRS) p-value was 0.022 after 84 months
This study demonstrates DBS as an effective treatment option for patients with different dystonia types such as generalized dystonia, cervical dystonia, and various brain pathology induced dystonias
Summary
Dystonia is a movement disorder substantially affecting the quality of life. Botulinum Neurotoxin (BoNT) is used intramuscularly as a treatment for dystonia; not all dystonia patients respond to this treatment. Conclusions: This study illustrates DBS is an established, effective treatment option for patients with different dystonias, such as generalized, cervical, and various brain pathology-induced dystonias. Group II describes the etiology of the disorders such as inherited or acquired, and with clinical evidence such as brain injuries or genetic causes [1,2] These classifications help to avoid previous terming of primary or secondary dystonias where clinicians would provide an etiological diagnosis for patients that remain unclear despite extensive workups for new genetic etiologies [2]. A few years later, Sanghera et al compared his hypothesis in their study with 15 patients with dystonia and 78 patients with PD [14–16] They reported that GPe and GPi neurons displayed similar discharge rates and discharge patterns in dystonia to that of PD, but firing neurons were significantly lower than those in PD patients. They concluded that a hypoactive basal ganglia output is not a consistent feature of dystonia, and that anesthesia may have a marked influence on basal ganglia firing rates and patterns [16–18]
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