What's new in surgical treatment for dystonia?

Authors


  • Relevant conflicts of interest/financial disclosures: E. Moro has received honoraria from Medtronic on consulting service and lecturing. She has received research grant support from the Canadian Institutes of Health Research, CurePSP, and St. Jude Medical. R. E. Gross is a consultant to St. Judes Medical Corporation, Boston Scientific Corporation, Medtronic/Lilly. JK Krauss is a consultant to Medtronic and received grant support from the German Research Council DFG.

  • Author roles may be found in the Acknowledgments section online.

Correspondence to: Dr. Elena Moro, CHU de Grenoble, CS 10217, Grenoble 38043, France; drelenamoro@yahoo.com

ABSTRACT

It is now established that pallidal deep brain stimulation (DBS) is effective in the treatment of generalized and segmental primary dystonia, although there is still insufficient evidence to support its benefit in focal and secondary dystonia. Because several studies have demonstrated that pallidal DBS improves quality of life (QoL), reduced QoL and disability that are nonresponsive to medical treatment are probably the main factors guiding the decision to consider surgery. Some studies have indicated that young patients with primary dystonia who have shorter disease duration and less severe dystonia are likely to have the best outcome from DBS. Therefore, surgery should not be delayed when disability and QoL are impaired to the extent that justifies the surgical risk. A case-by-case approach is recommended in patients who have secondary dystonia. The globus pallidus internus is considered the best target for dystonia. There are still not enough data about the effectiveness of thalamic, subthalamic nucleus, and premotor cortex stimulation. Targeting with multiple electrodes and intra-individual comparisons of outcomes may help determine which target would be more beneficial. With regard to the role of lesions, pallidotomy for dystonia is still performed in several countries and can play a role in selected patients. New technologies are already available to improve the stimulation programming for DBS patients and to increase battery longevity. In the near future, it is possible that we will be able to shape stimulation settings according to disease type and symptoms. © 2013 Movement Disorder Society

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