Surgical treatment for secondary dystonia

Abstract

Surgical therapy for the secondary dystonias is generally perceived to be less effective than for primary disease. However, a number of case reports and small open series have recently appeared describing quite favorable outcomes following surgery for some nonprimary dystonias. We discuss surgical treatment options for this group of diverse conditions, including tardive dystonia, dystonic cerebral palsy, and certain heredodegenerative diseases in which deep brain stimulation and ablative lesions of the posteroventral pallidum have been shown to be effective. Other types of secondary dystonia respond less well to pallidal surgery, particularly when anatomical lesions of the basal ganglia are prominent on preoperative imaging. For these conditions, central baclofen delivery and botulinum toxin denervation may be considered. With optimal medical and surgical care, some patients with secondary dystonia have achieved reductions in disability and pain that approach those documented for primary dystonia.

Deep anterior cerebellar stimulation reduces symptoms of secondary dystonia in patients with cerebral palsy treated due to spasticity

“…Surgical therapy for the secondary dystonias is generally perceived to be less effective than for primary disease [5][6][7]. In secondary dystonia effects of neurostimulation can be low [8][9][10].…”

“…Patients with this type of CP have symptoms of spasticity which coexist with symptoms of focal or segmental dystonia. Pharmacological treatment of dystonic movements is unsatisfactory and is burden with side effects [5].…”

Deep brain stimulation for the treatment of childhood dystonic cerebral palsy

“…5 The posteroventrolateral globus pallidus internus (GPi) has become a well-established target for deep brain stimulation (DBS) in both primary and secondary dystonia. 23,35 While primary dystonia has been shown to respond robustly to pallidal stimulation in both adults and children, 1,2,6,12,21,29,39 secondary dystonia, especially that related to CP, appears to be less responsive. 1,2,9,21,23,27,30 The inherent difficulty in evaluating the effect of DBS within this heterogeneous population is that the literature is sparse and fraught with case series that include incomplete data, involve the inconsistent use of dystonia rating scales that may not be sensitive to the subtleties of secondary dystonia, and consist of patients of different age groups suffering from various forms of secondary dystonia.…”

Treatment of Dystonia

“…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]. Reports of response to DBS in patients with cerebral palsy have demonstrated improvement at 6 months [69] and 1 year postsurgery [70].…”