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Sixty hertz pallidal deep brain stimulation for primary torsion dystonia

From Mount Sinai School of Medicine (R.L.A., J.M., D.W., M.T.), New York; and Beth Israel Medical Center (J.L.S., S.B.B.), New York, NY.

Address correspondence and reprint requests to Dr. Michele Tagliati, Associate Professor, Department of Neurology, Mount Sinai School of Medicine, 5 East 98th Street, Box 1139, New York, NY 10029 michele.tagliati{at}mssm.edu

Objective: To evaluate the safety and efficacy of 60 Hz deep brain stimulation (DBS) of the globus pallidus internus (GPi) in 15 consecutive patients with primary dystonia.

Methods: We conducted a retrospective analysis of clinic charts relative to 15 consecutive patients with medically refractory primary dystonia who underwent stereotactic implantation of DBS leads within the GPi. Twelve had the DYT1 gene mutation. Frame-based MRI and intraoperative microelectrode recording were employed for targeting. All patients were treated exclusively with stimulation at 60 Hz from therapy outset. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) served as the primary measure of symptom severity at baseline and 1, 3, 6, and 12 months after treatment.

Results: All patients tolerated DBS treatment well and showed a progressive median improvement of their BFMDRS motor subscores from 38% at 1 month to 89% at 1 year (p < 0.001, Wilcoxon rank sum test). The disability subscores were similarly improved. The clinical response to DBS allowed seven patients to completely discontinue their medications; six additional patients had reduced their medications by at least 50%. Surgical complications were limited to two superficial infections, which were treated successfully.

Conclusions: Stimulation of the internal globus pallidus at 60 Hz is safe and effective for treating medically refractory primary dystonia.

Supplemental data at www.neurology.org

Funded in part by a grant from the Bachmann-Strauss Foundation.

Disclosure: Drs. Ron Alterman and Michele Tagliati have received consulting fees and speaking honoraria—not related to this work—by Medtronic Inc.

Received December 5, 2006. Accepted in final form March 21, 2007.

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