Deep brain stimulation for dystonia: outcome at long-term follow-up

Loher, Thomas J.; Capelle, Hans‐Holger; Kaelin‐Lang, Alain; Weber, Sabine; Weigel, Ralf; Burgunder, Jean‐Marc; Krauss, Joachim K.

doi:10.1007/s00415-008-0798-6

Cited by 127 publications

(114 citation statements)

References 20 publications

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“…15 Meige syndrome has become the most common eponym current used in the literature. 2,3,6,9,11,13,21,23,24,27,30 Meige syndrome is characterized by blepharospasm, cervical dystonia, and facial oromandibular dystonia. The underlying cause of Meige syndrome is unknown, but most investigators consider it a variant of idiopathic torsion dystonia.…”

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confidence: 99%

Long-term follow-up of deep brain stimulation for Meige syndrome

Lyons¹,

Birch²,

Hillman

et al. 2010

FOC

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Object Meige syndrome is characterized by blepharospasm, cervical dystonia, and facial oromandibular dystonia. The medical treatment of this condition is largely unsuccessful over time and is a major source of decreased quality of life in those patients suffering from this disease. Recent advances in the application of deep brain stimulation (DBS) surgery techniques for many disorders have prompted several recent reports of DBS for medically refractory cases of Meige syndrome. While the etiology for this disorder is unknown, it is considered by many investigators to be a form of idiopathic torsion dystonia. Pallidal stimulation is widely considered to be effective for dystonia. Methods The authors report the long-term results of bilateral globus pallidus internus (GPi) or subthalamic nucleus (STN) stimulation in 3 patients with Meige syndrome and 1 patient with Parkinson disease and associated craniofacial dystonia treated at their center. Results Initial 12-month and long-term follow-up Burke-Fahn-Marsden scores were substantially improved in all 4 patients compared with preoperative scores. Conclusions Bilateral GPi DBS may be an effective and safe treatment for medically refractory Meige syndrome. The results are comparable with those reported in the literature. Sustained and long-term improvement in symptoms does appear to be reproducible across reports. The authors' patient with Parkinson disease and associated craniofacial dystonia syndrome undergoing bilateral STN DBS noted immediate and sustained improvement in his symptoms. Further study is required, but these results, along with the other reports, suggest that bilateral GPi DBS is an effective treatment for medically refractory Meige syndrome.

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confidence: 99%

Long-term follow-up of deep brain stimulation for Meige syndrome

Lyons¹,

Birch²,

Hillman

et al. 2010

FOC

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…Deep brain stimulation (DBS) has emerged as an effective treatment for idiopathic generalized and some focal dystonias [1,2]. It is also increasingly utilized in patients with symptomatic or secondary dystonias, such as those due to cerebral palsy, post-traumatic dystonia, post-stroke dystonia, tardive dystonia, neurodegenerative or metabolic disorders such as pantothenate [3].…”

Section: Introductionmentioning

confidence: 99%

“…It is also increasingly utilized in patients with symptomatic or secondary dystonias, such as those due to cerebral palsy, post-traumatic dystonia, post-stroke dystonia, tardive dystonia, neurodegenerative or metabolic disorders such as pantothenate [3]. kinase-associated neurodegeneration (PKAN), and other disorders, although they may be less responsive to DBS [1,[4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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

Section: Introductionmentioning

confidence: 99%

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Botulinum toxin injection following deep brain stimulation in generalized dystonia

Karp¹,

Ramos²,

Alter³

et al. 2017

Clin Res Trials

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Deep Brain Stimulation for Primary Generalized Dystonia

Isaias¹,

Alterman²,

Tagliati³

2009

Arch Neurol

181

106

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Background: Pallidal deep brain stimulation (DBS) is the best therapeutic option for patients with disabling primary generalized dystonia (PGD) that is refractory to medications. However, little is known about its long-term effects.Objective: To describe long-term clinical outcomes in patients with PGD who underwent pallidal DBS.Design: Case series.Setting: University hospital.Patients: Thirty consecutive patients with at least 2 years' follow-up after pallidal DBS for intractable PGD.Interventions: Pallidal DBS and annual follow-up examinations up to 8 years after DBS implantation.Main Outcome Measures: Clinical outcome as measured by changes in the Burke-Fahn-Marsden dystonia scale, incidence and prevalence of adverse events, total electrical energy delivered, and implantable pulse generator longevity.Results: Twenty-three patients were followed for 3 years, 13 for 4 years, 9 for 5 years, 5 for 6 years, 5 for 7 years, and 1 for 8 years after DBS. Overall improvement at 1 year was maintained in all at successive yearly examinations. There were no intraoperative complications; hardware-related adverse events were infrequent. Rare stimulation-related adverse events primarily affected speech. Implantable pulse generators were replaced every 24 months on average in patients who received initial stimulation at 130-Hz frequency. No battery was replaced, for up to 48 months, in 20 patients initially stimulated using 60 Hz. Clinical outcome did not depend on high energies of stimulation.Conclusions: Pallidal DBS is a safe and effective treatment for PGD, with improvement sustained for up to 8 years in 1 patient. Low energies of stimulation, although they did not affect clinical outcome, were associated with longer battery life.

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Deep brain stimulation for dystonia: outcome at long-term follow-up

Abstract: DBS maintains marked long-term symptomatic and functional improvement in the majority of patients with dystonia.

Cited by 127 publications

References 20 publications

Long-term follow-up of deep brain stimulation for Meige syndrome

Long-term follow-up of deep brain stimulation for Meige syndrome

Botulinum toxin injection following deep brain stimulation in generalized dystonia

Deep Brain Stimulation for Primary Generalized Dystonia

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