Deep Brain Stimulation for Dystonia: A Meta-Analysis

Unilateral thalamic and pallidal deep brain stimulation for idiopathic hemidystonia: results of individual and combined stimulations. Case report

“…22,24 Not all studies were designed initially for combined stimulation; in some studies a secondary surgery was performed to implant electrodes at different targets after failure of the first. 9,17,24 A 2006 meta-analysis 9 showed that the GPi stimulation had significantly better outcomes compared with the posterior portion of the ventrolateral nucleus of the thalamus, which includes Vim and part of the ventral oral (Vo) complex, 9,16 but the majority of the patients reviewed had primary dystonia. 9 The thalamic anatomy has many descriptions that could lead to targeting changes, and the fact that it has unclear and overlapped nuclear borders interferes with the clinical analysis.…”

“…9,17,24 A 2006 meta-analysis 9 showed that the GPi stimulation had significantly better outcomes compared with the posterior portion of the ventrolateral nucleus of the thalamus, which includes Vim and part of the ventral oral (Vo) complex, 9,16 but the majority of the patients reviewed had primary dystonia. 9 The thalamic anatomy has many descriptions that could lead to targeting changes, and the fact that it has unclear and overlapped nuclear borders interferes with the clinical analysis. Even changes inside a thalamic nucleus can have a different effect; for example, the posteromedial part of the Vim can treat tremor and drug-induced dyskinesias, and the anterolateral part can only treat tremor, 22 which can also be explained by stimulation of a nearby nucleus.…”

“…Stereotactic ablation of the globus pallidus internus (GPi) and thalamus are being massively replaced by deep brain stimulation (DBS). 5,9,10,14,21,22,24 Pallidal stimulation is indicated for several types of dystonia, especially the primary type with hyperkinetic movements. However, other targets such as the thalamus and the subthalamic nucleus (STN) show good results in tremor, myoclonus, and task-specific dystonia, and for rescue therapy.…”

“…However, other targets such as the thalamus and the subthalamic nucleus (STN) show good results in tremor, myoclonus, and task-specific dystonia, and for rescue therapy. [4][5][6][8][9][10][12][13][14][16][17][18]20 A precise target has not been established for each type of dystonia, 14,16 and it is known that the etiology interferes with the surgical outcome. Hemidystonia is not well treated by a single target because of its complex rearrangement of the motor network, 4 and hypokinetic symptoms don't respond well to pallidal modulation.…”

The History and Future of Deep Brain Stimulation

“…61 In addition, although there has been one rigorous trial examining the efficacy of GPi DBS in primary dystonia, 56 the reports of DBS for secondary dystonia consist of small case series. 62 Trials are underway to examine the efficacy of DBS for tardive dystonia (Clinicaltrials. gov, Identifier No.…”