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Abstract

Objectives:

The globus pallidus internus (GPi) has been the primary target for deep brain stimulation (DBS) to treat severe medication-refractory dystonia. Some patients with primary cervical or segmental dystonia develop subtle bradykinesia occurring in previously nondystonic body regions during GPi DBS. Subthalamic nucleus (STN) DBS may provide an alternative target choice for treating dystonia, but has only been described in a few short reports, without blinded rating scales, statistical analysis, or detailed neuropsychological studies.

Methods:

In this prospective pilot study, we analyzed the effect of bilateral STN DBS on safety, efficacy, quality of life, and neuropsychological functioning in 9 patients with medically refractory primary cervical dystonia. Severity of dystonia was scored by a blinded rater (unaware of the patient's preoperative or postoperative status) using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) preoperatively and 3, 6, and 12 months postsurgery. Lead location, medications, and adverse events were also measured.

Results:

STN DBS was well-tolerated with no serious adverse effects. The TWSTRS total score improved (p < 0.001) from a mean (±SEM) of 53.1 (±2.57), to 19.6 (±5.48) at 12 months. Quality of life measures were also improved. STN DBS induced no consistent neuropsychological deficits. Several patients reported depression in the study and 3 had marked weight gain. No patients developed bradykinetic side effects from stimulation, but all patients developed transient dyskinetic movements during stimulation.

Conclusions:

This prospective study showed that bilateral STN DBS resulted in improvement in dystonia and suggests that STN DBS may be an alternative to GPi DBS for treating primary cervical dystonia.

Classification of evidence:

This study provides Class III evidence that bilateral subthalamic nucleus deep brain stimulation results in significant improvement in cervical dystonia without bradykinetic side effects.

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Supplementary Material

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Information & Authors

Information

Published In

Neurology®
Volume 76Number 10March 8, 2011
Pages: 870-878
PubMed: 21383323

Publication History

Received: August 19, 2010
Accepted: November 18, 2010
Published online: March 7, 2011
Published in print: March 8, 2011

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Disclosure

Dr. Ostrem serves on the speakers' bureau for and has received funding for travel and speaker honoraria from Allergan, Inc.; serves as a consultant for Boston Scientific; performs clinical examinations (80% effort) for the UCSF Surgical Movement Disorders Center; and receives research support from Ceregene, St. Jude Medical, Inc., SurgiVision, Inc., Allergan, Inc., the NIH, UC Discovery Grant, and the Benign Essential Blepharospasm Research Foundation. Dr. Racine has served as a consultant for Novartis and has received/receives research support from Novartis, UC Discovery Grant Award, UCSF Brain Tumor SPORE Developmental Award, private donors, and the Anonymous Foundation. Dr. Glass serves on the speakers' bureau for and has received funding for travel and speaker honoraria from Allergan, Inc. J.K. Grace reports no disclosures. M.M. Volz serves as a consultant and on the speakers' bureau for and has received funding for travel and speaker honoraria from Medtronic, Inc.; employs SurgiVision imaging technology (25% effort) in the UCSF Surgical Movement Disorders Practice; and receives research support from SurgiVision, Inc. and the Benign Essential Blepharospasm Research Foundation. S.L. Heath serves as a consultant and on the speakers' bureau for and has received funding for travel and speaker honoraria from Medtronic, Inc. Dr. Starr serves on a scientific advisory board for Protein Therapeutics, Inc.; serves on the editorial board of Stereotactic and Functional Neurosurgery; serves as a consultant for Boston Scientific; and receives research support from SurgiVision, Inc. the NIH, and the Dystonia Medical Research Foundation.

Authors

Affiliations & Disclosures

J.L. Ostrem, MD
From the Departments of Neurology (J.L.O., G.A.G., J.K.G., M.M.V.) and Neurological Surgery (C.A.R., P.A.S.), University of California, San Francisco, Surgical Movement Disorders, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., G.A.G., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, San Francisco, CA.
C.A. Racine, PhD
From the Departments of Neurology (J.L.O., G.A.G., J.K.G., M.M.V.) and Neurological Surgery (C.A.R., P.A.S.), University of California, San Francisco, Surgical Movement Disorders, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., G.A.G., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, San Francisco, CA.
G.A. Glass, MD
From the Departments of Neurology (J.L.O., G.A.G., J.K.G., M.M.V.) and Neurological Surgery (C.A.R., P.A.S.), University of California, San Francisco, Surgical Movement Disorders, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., G.A.G., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, San Francisco, CA.
J.K. Grace, BS
From the Departments of Neurology (J.L.O., G.A.G., J.K.G., M.M.V.) and Neurological Surgery (C.A.R., P.A.S.), University of California, San Francisco, Surgical Movement Disorders, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., G.A.G., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, San Francisco, CA.
M.M. Volz, MS, RN
From the Departments of Neurology (J.L.O., G.A.G., J.K.G., M.M.V.) and Neurological Surgery (C.A.R., P.A.S.), University of California, San Francisco, Surgical Movement Disorders, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., G.A.G., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, San Francisco, CA.
S.L. Heath, MS, RN
From the Departments of Neurology (J.L.O., G.A.G., J.K.G., M.M.V.) and Neurological Surgery (C.A.R., P.A.S.), University of California, San Francisco, Surgical Movement Disorders, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., G.A.G., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, San Francisco, CA.
P.A. Starr, MD, PhD
From the Departments of Neurology (J.L.O., G.A.G., J.K.G., M.M.V.) and Neurological Surgery (C.A.R., P.A.S.), University of California, San Francisco, Surgical Movement Disorders, San Francisco; and Parkinson's Disease Research, Education, and Clinical Center (J.L.O., G.A.G., S.L.H., P.A.S.), San Francisco Veterans Affairs Medical Center, San Francisco, CA.

Notes

Address correspondence and reprint requests to Dr. Jill L. Ostrem, Department of Neurology, Surgical Movement Disorders, 1635 Divisadero Street, Fifth Floor, Suites 520–530, San Francisco, CA 94115 [email protected]
Study funding: Supported by the Benign Essential Blepharospasm Research Foundation and by private donors Larry and Kana Miao.

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