Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective 3 year follow-up study

Treatment of Dystonia

“…At 12 months, there was significant clinical improvement in dystonia compared to the patients' pre-surgical baseline based on a blinded assessment. This benefit was sustained in a 3-year follow-up study [46]. One multicenter European study involving 40 patients found significantly greater improvement with bilateral GPi stimulation versus sham treatment based on blinded clinical assessment at 3 months [45].…”

Botulinum toxin injection following deep brain stimulation in generalized dystonia

“…GPi DBS, however, is a better approach for these patients, reducing generalized dystonic symptoms by 50-80% and improving quality of life, comfort and function [1,9]. Although patients with generalized dystonia that is acquired or due to a degenerative underlying disease have a less robust response to DBS, they often benefit sufficiently to justify the risks of surgery [7].…”

“…DBS typically improves generalized dystonia by about 50% on rating scales such as the Burke-Fahn-Marsden dystonia rating scale [1,9].…”

“…However, BoNT can successfully relieve spasm in discrete body areas [9][10][11]. Patients with generalized dystonia often receive BoNT injections for symptomatic control of specific symptoms before undergoing DBS.…”

12 Deep Brain Stimulation for Dystonia

“…DBS was first applied in cervical dystonia by Mundiner [6] in 1977. After that, two multicenter studies on bilateral Globus Pallidus pars Interna (GPi) DBS have demonstrated convincing clinical benefit on a large number of patients with primary generalized/segmental dystonia [7][8][9]. Accordingly, GPi DBS was approved by FDA in 2003 (as a humanitarian device exemption) for patients with chronic, medically intractable dystonia [10][11][12][13].…”