Surgical therapy for dystonia

Abstract

Surgical treatments for dystonia have been available since the early 20th century, but have improved in their efficacy to adversity ratio through a combination of technologic advances and better understanding of the role of the basal ganglia in dystonia. The word "dystonia" describes a phenotype of involuntary movement that may manifest from a variety of conditions. Dystonia may affect only certain regions of the body or may be generalized. It appears to be critical to determine whether the etiology underlying the dystonia is "primary" (ie, occurring from a genetic or idiopathic origin) or "secondary" (ie, occurring as a result of structural, metabolic, or neurodegenerative disorders). Secondary dystonias are far more common than primary dystonias. Primary dystonias respond well to pallidotomy or deep brain stimulation of the internal segment of the globus pallidum, whereas secondary dystonias appear to respond partially at best. Limited historic and current data suggest that the thalamus may be a promising target for the treatment of secondary dystonias, but more careful, prospective, randomized studies are needed. Combinations of bilateral targets are possible with the current technology of DBS, but not widely used due to surgical morbidity and expense. This article reviews the surgical treatment of dystonia from past to present, with a focus on separating the outcomes for primary versus secondary and generalized versus cervical dystonia.

Dystonia and Peripheral Nerve Surgery in the Cervical Area

“…A significant numbers of patient developed swallowing dysfunction following the surgery while improvement of cervical dystonia was not appreciable. Consequently, there is no use of bilateral C1-C3 anterior rhizotomy in the present (Brin & Benabou, 1999;Bronte-Stewart, 2003;Taira, 2009). However, recently, intradural C1-C2 anterior rhizotomy has been successfully combined with selective denervation of C3-C6 posterior rami successfully without serious adverse effect 2002;Taira, 2009).…”

“…It affected not only motor fibers to the sternocleidomastoid but also those to the trapezius. Postoperative trapezius atrophy and shoulder instability inevitably occurred (Bronte-Stewart, 2003;Sorensen & Hamby 1965).…”

“…Bilateral thalamotomy used to be an effective stereotactic ablative surgery for cervical dystonia (Bronte-Stewart, 2003;Dashtipour et al, 2007). Bilateral procedures, however, commonly resulted in speech disturbance (Bronte-Stewart, 2003;Imer et al, 2005;Krauss, 2010).…”

“…Bilateral procedures, however, commonly resulted in speech disturbance (Bronte-Stewart, 2003;Imer et al, 2005;Krauss, 2010). Presently, it is completely replaced by pallidal deep brain stimulation.…”

“…Nevertheless, the hypothesis of accessory nerve decompression cannot explain improvement of cervical dystonia in the individuals who have no dystonia of both the muscles (Albanese et al, 2006;Brin & Benabou, 1999;Bronte-Stewart, 2003;Taira, 2009). …”