Surgical approach to dystonia

ACTH and the Effects of Anticholinergic Drugs in Dystonia

“…Also, urinary steroid excretion is reportedly diminished in patients with cord transection above the thoracic region (Ganong, 1985). These ,observations could provide an interesting clue to the known reports that 1) cervical spinal cord stimulation improves the involuntary movements in some dystonic patients (Waltz et al, 1981;Waltz, 1982), and 2 ) the recent report by Tunkel et al, (1986) describing attenuation of torsion dystonia following cervical spine surgery that included C 3 laminectomy, C 2, C 3 and C 4 nerve root decompression and crushing of the C 3 nerve bilaterally. Although, in none of these cases was ACTH or cortisol measured, it is possible that the peripheral nerve injury associated with trauma to the cervical spine altered the release or synthesis of ACTH, thus triggering the onset of dystonia in some patients (Schott, 1985) and attenuating dystonic movements in other patients (Tunkel et al, 1986).…”

Computerized Percutaneous Multi-Level Spinal Cord Stimulation in Motor Disorders

“…This series represents a continuation of our previously reported observations [6,8,9] and includes 90 patients with cerebral palsy, 55 with dystonia, 26 with spasmodic tor ticollis, 33 with degenerative neurologic disease and 22 patients with post-traumatic spasticity.…”

“…Initial results were encouraging. Analysis of results for the first 100 patients demonstrated a distinct area of positive response, with the best results occurring with the electrode placed in the cervical area between C-2 and C-4 [6]. Con ventional systems available at the time had two electrodes and allowed only single level stimulation.…”

“…Initially, this was demon strated in multiple sclerosis [2], other degenerative diseases [1,3] and spasmodic torticollis [4], This therapeutic application of spinal cord stimulation has been more recently extended by us to include other dis orders of the motor system, including cerebral palsy, dystonia, torticol lis, post-traumatic and post-stroke spasticity [5,6,9]. The effectiveness of spinal cord stimulation has been shown to be increased by the use of variable spinal cord stimulation, which allows multiple anatomical and physiologic levels of stimulation to be carried out [9], In 1975, we began investigating spinal cord stimulation in the treatment of motor disorders, including cerebral palsy, dystonia, tor ticollis, post-stroke and post-traumatic spasticity.…”