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Bilateral subthalamic nucleus stimulation for generalized dystonia after bilateral pallidotomy

Authors

  • Erich Talamoni Fonoff MD, PhD,

    Corresponding author
    1. Division of Functional Neurosurgery, Department of Neurology of School of Medicine of University of São Paulo, São Paulo SP, Brazil
    • Division of Functional Neurosurgery, Department of Neurology, University of São Paulo School of Medicine, Rua Dr. Ovídio Pires de Campos, 785, 01060-970, São Paulo, SP, Brasil
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  • Wuilker Knoner Campos MD,

    1. Division of Functional Neurosurgery, Department of Neurology of School of Medicine of University of São Paulo, São Paulo SP, Brazil
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  • Maurício Mandel MD,

    1. Division of Functional Neurosurgery, Department of Neurology of School of Medicine of University of São Paulo, São Paulo SP, Brazil
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  • Eduardo Joaquim Lopes Alho MD,

    1. Division of Functional Neurosurgery, Department of Neurology of School of Medicine of University of São Paulo, São Paulo SP, Brazil
    2. “Julius-Maximilians Universität Würzburg” Labor für Morphologische Hirnforschung (Laboratory for Morphological Brain Research), Würzburg, Germany
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  • Manoel Jacobsen Teixeira MD, PhD

    1. Division of Functional Neurosurgery, Department of Neurology of School of Medicine of University of São Paulo, São Paulo SP, Brazil
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  • Relevant conflicts of interest/financial disclosures: Nothing to report.

  • Full financial disclosures and author roles may be found in the online version of this article.

Abstract

Background:

Thalamotomies and pallidotomies were commonly performed before the deep brain stimulation (DBS) era. Although ablative procedures can lead to significant dystonia improvement, longer periods of analysis reveal disease progression and functional deterioration. Today, the same patients seek additional treatment possibilities.

Methods:

Four patients with generalized dystonia who previously had undergone bilateral pallidotomy came to our service seeking additional treatment because of dystonic symptom progression. Bilateral subthalamic nucleus DBS (B-STN-DBS) was the treatment of choice. The patients were evaluated with the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS) and the Unified Dystonia Rating Scale (UDRS) before and 2 years after surgery.

Results:

All patients showed significant functional improvement, averaging 65.3% in BFMDRS (P = .014) and 69.2% in UDRS (P = .025).

Conclusions:

These results suggest that B-STN-DBS may be an interesting treatment option for generalized dystonia, even for patients who have already undergone bilateral pallidotomy. © 2012 Movement Disorder Society

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