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Predictive factors of outcome in primary cervical dystonia following pallidal deep brain stimulation

Authors

  • Jennifer L. Witt MD,

    1. Surgical Movement Disorders, Department of Neurology, University of California, San Francisco, California, USA
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    • Dr. Witt and Dr. Moro contributed equally to this work.

  • Elena Moro MD, PhD,

    1. Movement Disorders Centre, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
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    • Dr. Witt and Dr. Moro contributed equally to this work.

  • Rima S. Ash MD,

    1. Surgical Movement Disorders, Department of Neurology, University of California, San Francisco, California, USA
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  • Clement Hamani MD,

    1. Division of Neurosurgery, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
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  • Philip A. Starr MD, PhD,

    1. Surgical Movement Disorders, Department of Neurological Surgery, University of California, San Francisco, California, USA
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  • Andres M. Lozano MD, PhD,

    1. Division of Neurosurgery, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
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  • Mojgan Hodaie MD,

    1. Division of Neurosurgery, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
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  • Yu-Yan Poon RN,

    1. Movement Disorders Centre, Toronto Western Hospital, University Health Network (UHN), University of Toronto, Toronto, Ontario, Canada
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  • Leslie C. Markun MSc,

    1. Surgical Movement Disorders, Department of Neurology, University of California, San Francisco, California, USA
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  • Jill L. Ostrem MD

    Corresponding author
    1. Surgical Movement Disorders, Department of Neurology, University of California, San Francisco, California, USA
    • Correspondence to: Dr. Jill L. Ostrem, Surgical Movement Disorders, Department of Neurology, University of California, 1635 Divisadero St., Suite 520/530, San Francisco, CA 94115, USA; jill.ostrem@ucsf.edu

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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

Improvement after bilateral globus pallidus internus deep brain stimulation (DBS) in primary generalized dystonia has been negatively associated with disease duration and age, but no predictive factors have been identified in primary cervical dystonia (CD).

Methods

Patients treated with bilateral globus pallidus internus DBS for primary CD from 2 DBS centers with preoperative and postoperative Toronto Western Spasmodic Torticollis Rating Scales (TWSTRS) were studied retrospectively to explore possible predictors of response.

Results

Patients showed significantly improved TWSTRS total and severity scores (n = 28, mean 55.6% and 50.8%, respectively, both P < .001). Patients with lateral shift at baseline had less improvement in TWSTRS severity subscores (P = .02). No correlations between outcomes and disease duration, age at dystonia onset or surgery, baseline scores, or other included variables were found.

Conclusions

Although this is the largest study supporting efficacy of bilateral pallidal DBS in primary CD, no major clinical predictive outcomes of surgical benefit were identified. © 2013 International Parkinson and Movement Disorder Society

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