Pallidal deep brain stimulation for dystonia: a long term study. Issue 11 (28th September 2017)

• Record Type: Journal Article
• Authors: Meoni, Sara; Fraix, Valérie; Castrioto, Anna; Benabid, Alim Louis; Seigneuret, Eric; Vercueil, Laurent; Pollak, Pierre; Krack, Paul; Chevrier, Eric; Chabardes, Stephan; Moro, Elena
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 88:Issue 11(2017)
• Page Start: 960
• Page End: 967
• Publication Date: 2017-09-28
• Subjects: deep brain stimulation -- dystonia -- globus pallidus -- motor outcome; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2016-315504
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Pallidal deep brain stimulation (globus pallidus internus (GPi) DBS) is the best therapeutic option for disabling isolated idiopathic (IID) and inherited (INH) dystonia. Acquired dystonia (AD) may also benefit from GPi DBS. Efficacy and safety in the long-term remained to be established. Objective: To retrospectively assess long-term clinical outcomes and safety in dystonic patients who underwent GPi DBS. Methods: Patients were videotaped and assessed preoperatively and postoperatively (1-year and at last available follow-up) using the Burke-Fahn-Marsden Dystonia Rating Scale (motor score (BFMDRS-M); disability score (BFMDRS-D)). Results: Sixty-one patients were included (follow-up 7.9±5.9 years; range 1–20.7). In IID and INH (n=37), the BFMDRS-M improved at first (20.4±24.5; p<0.00001) and last (22.2±18.2; p<0.001) follow-ups compared with preoperatively (50.5±28.0). In AD (n=19), the BFMDRS-M ameliorated at 1-year (40.8±26.5; p<0.02) and late follow-ups (44.3±24.3; p<0.04) compared with preoperatively (52.8±24.2). In INH dystonia with other neurological features (n=4) there was no motor benefit. In IID and INH, the BFMDRS-D improved at 1-year (9.5±7.5; p<0.0002) and late follow-ups (10.4±7.8; p<0.016) compared with preoperatively (13.3±6.9). In AD, the BFMDRS-D reduced at 1-year (12.0±8.1; p<0.01) and late follow-ups (12.7 ±6.1; p=0.2) compared with preoperatively (14.35±5.7). Most adverse events were hardware related. Conclusions: GPi DBS is an effective and safe treatment in most patients with dystonia.