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Vol. 25. Num. 2.March - April 2014
Pages 49-98
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Vol. 25. Num. 2.March - April 2014
Pages 49-98
Clinical Research
DOI: 10.1016/j.neucir.2013.10.004
Evaluation of the efficacy of deep brain stimulation in the surgical treatment of cervical dystonia
Evaluación de la eficacia de la estimulación cerebral profunda en el tratamiento quirúrgico de distonía cervical
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Francisca Calheiros-Trigo??
Corresponding author
trigo.francisca@gmail.com

Corresponding author.
, Paulo Linhares
Neurosurgery Department, Centro Hospitalar de S. João, University of Porto, Porto, Portugal
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Tables (4)
Table 1. Demographic features of patients in this study.
Table 2. Stimulation settings after bilateral GPi – DBS.
Table 3. Toronto Western Spasmodic Torticollis Rating Scale severity subscores.
Table 4. Toronto Western Spasmodic Torticollis Rating Scale disability subscores.
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Abstract
Objective

Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a promising therapeutic option for patients with medically refractory dystonia. We present the results after 1 year of DBS of the GPi in 4 patients with cervical dystonia.

Materials and methods

Four patients with medically refractory cervical dystonia who underwent stereotactic pallidal DBS surgery between June 2010 and November 2011 were included in this retrospective study. Preoperative and postoperative evaluations at 3, 6 and 12 months after surgery were performed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).

Results

The 4 patients experienced a sustained improvement, with a mean TWSTRS reduction of 74.25%, at 12 months follow-up. Disability improved by 80.5% (mean) at 1 year follow-up. No stimulation-related side effects were reported.

Conclusion

Pallidal DBS is a valid and effective second-line treatment for patients with cervical focal dystonia. Our results support its use in patients with an insufficient response to medical treatment.

Keywords:
Deep brain stimulation
Focal idiopathic dystonia
Cervical dystonia
Movement disorder
Globus pallidus
Botulinum toxins
Resumen
Objetivo

La estimulación cerebral profunda (ECP) del globo pálido interno (GPi) es una terapéutica eficaz para pacientes con distonía refractaria al tratamiento médico. Presentamos 4 pacientes con distonía cervical refractaria operados con ECP utilizando como diana el GPi y los resultados un año después de la cirugía.

Material y métodos

Fueron incluidos en este estudio retrospectivo 4 pacientes con distonía cervical refractaria al tratamiento médico que fueron sometidos a cirugía estereotáctica para ECP del GPi entre junio 2010 y noviembre 2011. Fueron realizadas evaluaciones pre y postoperatorias a los 3, 6 y 12 meses utilizando la escala Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS).

Resultados

En los 4 pacientes se verificó un beneficio sustentado con una reducción media del 74,25% en las TWSTRS a los 12 meses de seguimiento. Un año después de la cirugía se obtuvo una mejoría media en la discapacidad del 80,5%. En ninguno de los pacientes de encontraron efectos secundarios relacionados con el procedimiento.

Conclusiones

ECP del GPi es un tratamiento quirúrgico válido y eficaz para la distonía cervical focal. Nuestros resultados apoyan su uso en aquellos pacientes con respuesta insuficiente al tratamiento médico.

Palabras clave:
Estimulación cerebral profunda
Distonía focal idiopática
Distonía cervical
Trastornos del movimiento
Globo pálido
Toxinas botulínicas

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