Long-Term Benefit Sustained after Bilateral Pallidal Deep Brain Stimulation in Patients with Refractory Tardive Dystonia

Abstract

Background/Aims: Tardive dystonia (TD) can be a highly disabling, permanent condition related to the use of dopamine-receptor-blocking medications. Our aim was to evaluate the long-term effect of bilateral pallidal deep brain stimulation (DBS) for TD. Methods: Five consecutive patients with disabling TD who underwent stereotactic placement of bilateral globus pallidus internus DBS leads were included. All patients had a history of mood disorder or schizophrenia previously treated with neuroleptic medication, with a mean duration of motor symptoms of 10.2 years. Dystonia severity was measured using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) movement score by a blinded neurologist reviewing pre- and postoperative videotaped examinations. Results: The mean baseline movement BFMDRS score was 49.7 (range 20–88). Overall, we observed a mean reduction of 62% in the BFMDRS movement score within the first year after surgery. Persistent improvement in dystonia (71%) was seen at the last follow-up ranging from 2 to 8 years after surgery. Conclusion: Our experience suggests that pallidal DBS can be an effective therapy with long-term benefits for patients with TD.

Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality?

“…The stimulation parameters are typically the same as for PD, although some patients may also respond to lower frequencies. There is growing evidence supporting the use of GPi DBS for the treatment of tardive dystonia or myoclonus dystonia [244][245][246][247][248][249][250][251][252][253][254]. Lesser and inconsistent benefit is seen in dystonia secondary to structural brain damage [255].…”

Pallidal deep brain stimulation: an effective treatment in Chinese patients with tardive dystonia

“…13 In contrast, the success of pallidal DBS in the treatment of primary dystonias led to its adoption for secondary dystonias such as TD. [5][6][7]14,15 In this series we demonstrate a significant beneficial effect for medically refractory TD where rapid remarkable improvements in motor symptoms were observed within days without exacerbation of psychiatric symptoms. Our results are in agreement with other DBS outcome trials for TD.…”

“…5,7,16 Long-term responses for 8 to 10 years have also been reported. 6,17 Although most data were from case studies or small trials, our experience supports DBS as an effective and safe surgical treatment modality that can considerably improve QoL.…”

“…On clinical follow-up, the effect has proven to be effective for secondary dystonias such as TD. [4][5][6][7] We report our experience with using DBS for treating three young ethnic Chinese patients with severe TD refractory to pharmacological management. …”

Treatment of Dystonia

“…While secondary dystonia is generally less responsive to DBS, one exception is tardive dystonia, for which there are Ona = onbotulinumtoxinA; Abo = abobotulinumtoxinA; Inco = incobotulinumtoxinA; Rima = rimabotulinumtoxinB; JRS = Jankovic Rating Scale; BDSI = Blepharospasm Disability Index; TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale several reports of robust improvement with long-term benefit [62,63]. Case reports of other forms of secondary dystonia responsive to DBS include neurodegeneration with brain iron accumulation, dopa-responsive dystonia, X-linked dystonia parkinsonism, and post-infarct hemidystonia [64][65][66][67][68].…”