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Surgical treatment for secondary dystonia


  • Relevant conflicts of interest/financial disclosures: T.S.T. has received grant funding from the American Association of Neurological Surgeons and the NIH; he has no financial relationship with any commercial interest, now or in the past. A.M.L. has served as a consultant to St. Jude Medical and Medtronic and holds intellectual property in the field of deep brain stimulation; he receives grant funding from the Canadian Institutes of Health Research. Neither author declares a conflict of interest with any drug, device, or intellectual property discussed in this article.

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


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. © 2012 Movement Disorder Society