Bilateral pallidal stimulation improves cervical dystonia for more than a decade. (December 2020)

• Record Type: Journal Article
• Authors: Kaelin-Lang, Alain; You, Hana; Burgunder, Jean-Marc; Lönnfors-Weitze, Tarja; Loher, Thomas J.; Taub, Ethan; Isaias, Ioannis U.; Krauss, Joachim K.; Michael Schüpbach, W.M.
• Is Part Of: Parkinsonism & related disorders. Volume 81(2020)
• Page Start: 78
• Page End: 81
• Publication Date: 2020-12
• Subjects: Cervical dystonia -- Deep brain stimulation -- Long term follow-up -- Globus pallidus internus; Parkinson's disease -- Periodicals; Movement disorders -- Periodicals; Movement Disorders -- Periodicals; Nerve Degeneration -- Periodicals; Nervous System Diseases -- Periodicals; Parkinson Disease -- Periodicals; Tremor -- Periodicals; Parkinson, Maladie de -- Périodiques; Parkinson's disease; 616.833
• DOI: 10.1016/j.parkreldis.2020.10.028
• Languages: English
• ISSNs: 1353-8020

Abstract

Abstract: Introduction: Deep brain stimulation (DBS) is an effective treatment in medically resistant cervical dystonia (CD) with a documented therapeutic effect. Long term outcome beyond a decade, however, has not been studied systematically. Methods: To investigate the impact of pallidal DBS beyond 10 years in CD we followed a series of five consecutive patients with severe medication-resistant CD. Severity of head and neck deviation, disability, and pain related to dystonia were assessed by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) in the frame of a prospective study. The primary endpoint of this study was a change in the TWSTRS total score. Secondary endpoints were changes in the subscores of the TWSTRS. Results: The mean follow-up time was 11.5 years (range 10–12.8). Comparing baseline and the last follow-up, CD improved by 53% on the total TWSTRS score, by 54.1% on the severity score, and by 70.1% on the disability score, while pain did not improve significantly. Improvement was stable over time. Patients with a tonic pattern of CD responded less to DBS than patients with a phasic pattern. DBS had no significant effect on mood and cognition. Two patients underwent electrode revisions. One patient had an infection of the proximal cable two years after surgery. Conclusions: Chronic bilateral pallidal stimulation improves severity of dystonia and disability over more than a decade in treatment resistant CD. Results may vary among individual patients. Highlights: Chronic pallidal DBS yielded improvement of cervical dystonia for more than a decade. Side effects were manageable in all patients. Individual responses varied depending on the clinical pattern of dystonia.