Chronic stimulation of the globus pallidus internus for treatment of non-DYT1 generalized dystonia and choreoathetosis: 2-year follow up

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  • 1 Departments of Neurology and Neurosurgery, Inselspital, University of Berne, Switzerland; and Department of Neurosurgery, University Hospital, Mannheim, Germany
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Object. The authors studied the long-term efficacy of deep brain stimulation (DBS) of the posteroventral lateral globus pallidus internus up to 2 years postoperatively in patients with primary non-DYT1 generalized dystonia or choreoathetosis. The results are briefly compared with those reported for DBS in DYT1 dystonia (Oppenheim dystonia), which is caused by the DYT1 gene.

Methods. Enrollment in this prospective expanded pilot study was limited to adult patients with severely disabling, medically refractory non-DYT1 generalized dystonia or choreoathetosis. Six consecutive patients underwent follow-up examinations at defined intervals of 3 months, 1 year, and 2 years postsurgery. There were five women and one man, and their mean age at surgery was 45.5 years. Formal assessments included both the Burke-Fahn-Marsden dystonia scale and the recently developed Unified Dystonia Rating Scale. Two patients had primary generalized non-DYT1 dystonia, and four suffered from choreoathetosis secondary to infantile cerebral palsy. Bilateral quadripolar DBS electrodes were implanted in all instances, except in one patient with markedly asymmetrical symptoms. There were no adverse events related to surgery.

The Burke-Fahn-Marsden scores in the two patients with generalized dystonia improved by 78 and 71% at 3 months, by 82 and 69% at 1 year, and by 78 and 70% at 2 years postoperatively. This was paralleled by marked amelioration of disability scores. The mean improvement in Burke-Fahn-Marsden scores in patients with choreoathetosis was 12% at 3 months, 29% at 1 year, and 23% at 2 years postoperatively, which was not significant. Two of these patients thought that they had achieved marked improvement at 2 years postoperatively, although results of objective evaluations were less impressive. In these two patients there was a minor but stable improvement in disability scores. All patients had an improvement in pain scores at the 2-year follow-up review. Medication was tapered off in both patients with generalized dystonia and reduced in two of the patients with choreoathetosis. All stimulation-induced side effects were reversible on adjustment of the DBS settings. Energy consumption of the batteries was considerably higher than in patients with Parkinson disease.

Conclusions. Chronic pallidal DBS is a safe and effective procedure in generalized non-DYT1 dystonia, and it may become the procedure of choice in patients with medically refractory dystonia. Postoperative improvement of choreoathetosis is more modest and varied, and subjective ratings of outcome may exceed objective evaluations.

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Contributor Notes

Address reprint requests to: Joachim K. Krauss, M.D., Department of Neurosurgery, University Hospital, Klinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany. email joachim.krauss@nch.ma.uni-heidelberg.de.
  • 1.

    Alkhani A, , Khan F, & Lang AE, et al: The response to pallidal surgery for dystonia is dependent on the etiology. Neurosurgery 47:504, 2000 (Abstract) Alkhani A, Khan F, Lang AE, et al: The response to pallidal surgery for dystonia is dependent on the etiology. Neurosurgery 47:504, 2000 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 2.

    Angelini L, , Nardocci N, & Estienne M, et al: Life-threatening dystonia-dyskinesias in a child: successful treatment with bilateral pallidal stimulation. Mov Disord 15:10101012, 2000 Angelini L, Nardocci N, Estienne M, et al: Life-threatening dystonia-dyskinesias in a child: successful treatment with bilateral pallidal stimulation. Mov Disord 15:1010–1012, 2000

    • Search Google Scholar
    • Export Citation
  • 3.

    Bereznai B, , Steude U, & Seelos K, et al: Chronic high-frequency globus pallidus internus stimulation in different types of dystonia: a clinical, video, and MRI report of six patients presenting with segmental, cervical, and generalized dystonia. Mov Disord 17:138144, 2002 Bereznai B, Steude U, Seelos K, et al: Chronic high-frequency globus pallidus internus stimulation in different types of dystonia: a clinical, video, and MRI report of six patients presenting with segmental, cervical, and generalized dystonia. Mov Disord 17:138–144, 2002

    • Search Google Scholar
    • Export Citation
  • 4.

    Bhatia KP, , Marsden CD, & Thomas DG: Posteroventral pallidotomy can ameliorate attacks of paroxysmal dystonia induced by exercise. J Neurol Neurosurg Psychiatry 65:604605, 1998 Bhatia KP, Marsden CD, Thomas DG: Posteroventral pallidotomy can ameliorate attacks of paroxysmal dystonia induced by exercise. J Neurol Neurosurg Psychiatry 65:604–605, 1998

    • Search Google Scholar
    • Export Citation
  • 5.

    Brin MF, , Germano I, & Danisi F, et al: Deep brain stimulation in the treatment of dystonia, inKrauss JK, , Jankovic J, & Grossman RG (eds): Surgery for Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 307315 Brin MF, Germano I, Danisi F, et al: Deep brain stimulation in the treatment of dystonia, in Krauss JK, Jankovic J, Grossman RG (eds): Surgery for Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 307–315

    • Search Google Scholar
    • Export Citation
  • 6.

    Burke RE, , Fahn S, & Marsden CD, et al: Validity and reliability of a rating scale for the primary torsion dystonias. Neurology 35:7377, 1985 Burke RE, Fahn S, Marsden CD, et al: Validity and reliability of a rating scale for the primary torsion dystonias. Neurology 35:73–77, 1985

    • Search Google Scholar
    • Export Citation
  • 7.

    Chuang C, , Fahn S, & Frucht SJ: The natural history and treatment of acquired hemidystonia: report of 33 cases and review of the literature. J Neurol Neurosurg Psychiatry 72:5967, 2002 Chuang C, Fahn S, Frucht SJ: The natural history and treatment of acquired hemidystonia: report of 33 cases and review of the literature. J Neurol Neurosurg Psychiatry 72:59–67, 2002

    • Search Google Scholar
    • Export Citation
  • 8.

    Comella CL: Rating scales for dystonia: a multicenter assessment of three dystonia rating scales: the unified dystonia rating scale (UDRS), the Burke-Fahn-Marsden (BFM) and the global dystonia rating scale (GDS). Neurology 56 (Suppl 3):A387, 2001 (Abstract) Comella CL: Rating scales for dystonia: a multicenter assessment of three dystonia rating scales: the unified dystonia rating scale (UDRS), the Burke-Fahn-Marsden (BFM) and the global dystonia rating scale (GDS). Neurology 56 (Suppl 3):A387, 2001 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 9.

    Cooper IS: Relief of juvenile involuntary movement disorders by chemopallidectomy. JAMA 164:12971301, 1957 Cooper IS: Relief of juvenile involuntary movement disorders by chemopallidectomy. JAMA 164:1297–1301, 1957

    • Search Google Scholar
    • Export Citation
  • 10.

    Coubes P, , Echenne B, & Roubertie A, et al: Traitement de la dystonie généralisée a début précoce par stimulation chronique bilatérale des globus pallidus internes. A propos d'un case. Neurochirurgie 45:139144, 1999 Coubes P, Echenne B, Roubertie A, et al: Traitement de la dystonie généralisée a début précoce par stimulation chronique bilatérale des globus pallidus internes. A propos d'un case. Neurochirurgie 45:139–144, 1999

    • Search Google Scholar
    • Export Citation
  • 11.

    Coubes P, , Roubertie A, & Vayssiere N, et al: Treatment of DYT1-generalised dystonia by stimulation of the internal globus pallidus. Lancet 355:22202221, 2000 Coubes P, Roubertie A, Vayssiere N, et al: Treatment of DYT1-generalised dystonia by stimulation of the internal globus pallidus. Lancet 355:2220–2221, 2000

    • Search Google Scholar
    • Export Citation
  • 12.

    Eidelberg D, , Moeller JR, & Ishikawa T, et al: The metabolic topography of idiopathic torsion dystonia. Brain 118:14731484, 1995 Eidelberg D, Moeller JR, Ishikawa T, et al: The metabolic topography of idiopathic torsion dystonia. Brain 118:1473–1484, 1995

    • Search Google Scholar
    • Export Citation
  • 13.

    Freed CR, , Greene PE, & Breeze RE, et al: Transplantation of embryonic dopamine neurons for severe Parkinson's disease. N Engl J Med 344:710719, 2001 Freed CR, Greene PE, Breeze RE, et al: Transplantation of embryonic dopamine neurons for severe Parkinson's disease. N Engl J Med 344:710–719, 2001

    • Search Google Scholar
    • Export Citation
  • 14.

    Ghika J, , Villemure JG, & Miklossy J, et al: Postanoxic generalized dystonia improved by bilateral Voa thalamic deep brain stimulation. Neurology 58:311313, 2002 Ghika J, Villemure JG, Miklossy J, et al: Postanoxic generalized dystonia improved by bilateral Voa thalamic deep brain stimulation. Neurology 58:311–313, 2002

    • Search Google Scholar
    • Export Citation
  • 15.

    Gill S, , Curran A, & Tripp J, et al: Hyperkinetic movement disorder in an 11-year-old child treated with bilateral pallidal stimulators. Dev Med Child Neurol 43:350353, 2001 Gill S, Curran A, Tripp J, et al: Hyperkinetic movement disorder in an 11-year-old child treated with bilateral pallidal stimulators. Dev Med Child Neurol 43:350–353, 2001

    • Search Google Scholar
    • Export Citation
  • 16.

    Iacono RP, , Kuniyoshi SM, & Schoonenberg T: Experience with stereotactics for dystonia: case examples. Adv Neurol 78:221226, 1998 Iacono RP, Kuniyoshi SM, Schoonenberg T: Experience with stereotactics for dystonia: case examples. Adv Neurol 78:221–226, 1998

    • Search Google Scholar
    • Export Citation
  • 17.

    Jankovic J: Re-emergence of surgery for dystonia. J Neurol Neurosurg Psychiatry 65:434, 1998 Jankovic J: Re-emergence of surgery for dystonia. J Neurol Neurosurg Psychiatry 65:434, 1998

    • Search Google Scholar
    • Export Citation
  • 18.

    Krack P, & Vercueil L: Review of the functional surgical treatment of dystonia. Eur J Neurol 8:389399, 2001 Krack P, Vercueil L: Review of the functional surgical treatment of dystonia. Eur J Neurol 8:389–399, 2001

    • Search Google Scholar
    • Export Citation
  • 19.

    Krauss JK, & Grossman RG: Operative techniques for pallidal surgery, in Krauss JK, , Grossman RG, & Jankovic J (eds): Pallidal Surgery for the Treatment of Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott-Raven, 1998, pp 121133 Krauss JK, Grossman RG: Operative techniques for pallidal surgery, in Krauss JK, Grossman RG, Jankovic J (eds): Pallidal Surgery for the Treatment of Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott-Raven, 1998, pp 121–133

    • Search Google Scholar
    • Export Citation
  • 20.

    Krauss JK, & Grossman RG: Principles and techniques of movement disorders surgery, in Krauss JK, , Jankovic J, & Grossman RG (eds): Surgery for Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 74109 Krauss JK, Grossman RG: Principles and techniques of movement disorders surgery, in Krauss JK, Jankovic J, Grossman RG (eds): Surgery for Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 74–109

    • Search Google Scholar
    • Export Citation
  • 21.

    Krauss JK, , King DE, & Grossman RG: Alignment correction algorithm for transformation of stereotactic anterior commissure/posterior commissure-based coordinates into frame coordinates in image-guided functional neurosurgery. Neurosurgery 42:806812, 1998 Krauss JK, King DE, Grossman RG: Alignment correction algorithm for transformation of stereotactic anterior commissure/posterior commissure-based coordinates into frame coordinates in image-guided functional neurosurgery. Neurosurgery 42:806–812, 1998

    • Search Google Scholar
    • Export Citation
  • 22.

    Krauss JK, , Loher TJ, & Pohle T, et al: Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy. J Neurol Neurosurg Psychiatry 72:249256, 2002 Krauss JK, Loher TJ, Pohle T, et al: Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy. J Neurol Neurosurg Psychiatry 72:249–256, 2002

    • Search Google Scholar
    • Export Citation
  • 23.

    Krauss JK, , Pohle T, & Weber S, et al: Bilateral stimulation of the globus pallidus internus for treatment of cervical dystonia. Lancet 354:837838, 1999 Krauss JK, Pohle T, Weber S, et al: Bilateral stimulation of the globus pallidus internus for treatment of cervical dystonia. Lancet 354:837–838, 1999

    • Search Google Scholar
    • Export Citation
  • 24.

    Kumar R, , Dagher A, & Hutchison WD, et al: Globus pallidus deep brain stimulation for generalized dystonia: clinical and PET investigation. Neurology 53:871874, 1999 Kumar R, Dagher A, Hutchison WD, et al: Globus pallidus deep brain stimulation for generalized dystonia: clinical and PET investigation. Neurology 53:871–874, 1999

    • Search Google Scholar
    • Export Citation
  • 25.

    Lenz FA, , Suarez JI, & Metman LV, et al: Pallidal activity during dystonia: somatosensory reorganisation and changes with severity. J Neurol Neurosurg Psychiatry 65:767770, 1998 Lenz FA, Suarez JI, Metman LV, et al: Pallidal activity during dystonia: somatosensory reorganisation and changes with severity. J Neurol Neurosurg Psychiatry 65:767–770, 1998

    • Search Google Scholar
    • Export Citation
  • 26.

    Lin JJ, , Lin SZ, & Chang DC: Pallidotomy and generalized dystonia. Mov Disord 14:10571059, 1999 Lin JJ, Lin SZ, Chang DC: Pallidotomy and generalized dystonia. Mov Disord 14:1057–1059, 1999

    • Search Google Scholar
    • Export Citation
  • 27.

    Loher TJ, , Burgunder JM, & Pohle T, et al: Long-term pallidal deep brain stimulation in patients with advanced Parkinson disease: 1-year follow-up study. J Neurosurg 96:844853, 2002 Loher TJ, Burgunder JM, Pohle T, et al: Long-term pallidal deep brain stimulation in patients with advanced Parkinson disease: 1-year follow-up study. J Neurosurg 96:844–853, 2002

    • Search Google Scholar
    • Export Citation
  • 28.

    Loher TJ, , Hasdemir MG, & Burgunder JM, et al: Long-term follow-up study of chronic globus pallidus internus stimulation for posttraumatic hemidystonia. J Neurosurg 92:457460, 2000 Loher TJ, Hasdemir MG, Burgunder JM, et al: Long-term follow-up study of chronic globus pallidus internus stimulation for posttraumatic hemidystonia. J Neurosurg 92:457–460, 2000

    • Search Google Scholar
    • Export Citation
  • 29.

    Loher TJ, , Krauss JK, & Burgunder JM, et al: Chronic thalamic stimulation for treatment of dystonic paroxysmal nonkinesigenic dyskinesia. Neurology 56:268270, 2001 Loher TJ, Krauss JK, Burgunder JM, et al: Chronic thalamic stimulation for treatment of dystonic paroxysmal nonkinesigenic dyskinesia. Neurology 56:268–270, 2001

    • Search Google Scholar
    • Export Citation
  • 30.

    Lozano AM, , Kumar R, & Gross RE, et al: Globus pallidus internus pallidotomy for generalized dystonia. Mov Disord 12:865870, 1997 Lozano AM, Kumar R, Gross RE, et al: Globus pallidus internus pallidotomy for generalized dystonia. Mov Disord 12:865–870, 1997

    • Search Google Scholar
    • Export Citation
  • 31.

    Magyar-Lehmann S, , Antonini A, & Roelcke U, et al: Cerebral glucose metabolism in patients with spasmodic torticollis. Mov Disord 12:704708, 1994 Magyar-Lehmann S, Antonini A, Roelcke U, et al: Cerebral glucose metabolism in patients with spasmodic torticollis. Mov Disord 12:704–708, 1994

    • Search Google Scholar
    • Export Citation
  • 32.

    Marsden CD, , Obeso JA, & Zarranz JJ, et al: The anatomical basis of symptomatic hemidystonia. Brain 108:463483, 1985 Marsden CD, Obeso JA, Zarranz JJ, et al: The anatomical basis of symptomatic hemidystonia. Brain 108:463–483, 1985

    • Search Google Scholar
    • Export Citation
  • 33.

    Muta D, , Goto S, & Nishikawa S, et al: Bilateral pallidal stimulation for idiopathic segmental axial dystonia advanced from Meige syndrome refractory to bilateral thalamotomy. Mov Disord 16:774777, 2001 Muta D, Goto S, Nishikawa S, et al: Bilateral pallidal stimulation for idiopathic segmental axial dystonia advanced from Meige syndrome refractory to bilateral thalamotomy. Mov Disord 16:774–777, 2001

    • Search Google Scholar
    • Export Citation
  • 34.

    Naumann M, , Pirker W, & Reiners K, et al: Imaging the pre- and postsynaptic side of striatal dopaminergic synapses in idiopathic cervical dystonia: a SPECT study using [123I] epidepride and [123I] beta-CIT. Mov Disord 13:319323, 1998 Naumann M, Pirker W, Reiners K, et al: Imaging the pre- and postsynaptic side of striatal dopaminergic synapses in idiopathic cervical dystonia: a SPECT study using [123I] epidepride and [123I] beta-CIT. Mov Disord 13:319–323, 1998

    • Search Google Scholar
    • Export Citation
  • 35.

    Ondo WG, , Desaloms JM, & Jankovic J, et al: Pallidotomy for dystonia. Mov Disord 13:693698, 1998 Ondo WG, Desaloms JM, Jankovic J, et al: Pallidotomy for dystonia. Mov Disord 13:693–698, 1998

    • Search Google Scholar
    • Export Citation
  • 36.

    Ondo WG, , Desaloms M, & Krauss JK, et al: Pallidotomy and thalamotomy for dystonia, in Krauss JK, , Jankovic J, & Grossman RG (eds): Surgery for Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 299306 Ondo WG, Desaloms M, Krauss JK, et al: Pallidotomy and thalamotomy for dystonia, in Krauss JK, Jankovic J, Grossman RG (eds): Surgery for Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 299–306

    • Search Google Scholar
    • Export Citation
  • 37.

    Ondo WG, & Krauss JK: Surgical therapies for dystonia, in Brin MF, , Comella C, & Jankovic J (eds): Dystonia Monograph. Philadelphia: Lippincott Williams & Wilkins (In press) Ondo WG, Krauss JK: Surgical therapies for dystonia, in Brin MF, Comella C, Jankovic J (eds): Dystonia Monograph. Philadelphia: Lippincott Williams & Wilkins (In press)

    • Search Google Scholar
    • Export Citation
  • 38.

    Parkin S, , Aziz T, & Gregory R, et al: Bilateral internal globus pallidus stimulation for the treatment of spasmodic torticollis. Mov Disord 16:489493, 2001 Parkin S, Aziz T, Gregory R, et al: Bilateral internal globus pallidus stimulation for the treatment of spasmodic torticollis. Mov Disord 16:489–493, 2001

    • Search Google Scholar
    • Export Citation
  • 39.

    Pettigrew LC, & Jankovic J: Hemidystonia: a report of 22 patients and a review of the literature. J Neurol Neurosurg Psychiatry 48:650667, 1985 Pettigrew LC, Jankovic J: Hemidystonia: a report of 22 patients and a review of the literature. J Neurol Neurosurg Psychiatry 48:650–667, 1985

    • Search Google Scholar
    • Export Citation
  • 40.

    Sellal F, , Hirsch E, & Barth P, et al: A case of symptomatic hemidystonia improved by ventroposterolateral thalamic electrostimulation. Mov Disord 8:515518, 1993 Sellal F, Hirsch E, Barth P, et al: A case of symptomatic hemidystonia improved by ventroposterolateral thalamic electrostimulation. Mov Disord 8:515–518, 1993

    • Search Google Scholar
    • Export Citation
  • 41.

    Tasker RR: Surgical treatment of the dystonias, in Gildenberg PL, & Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery. New York: McGraw-Hill, 1998, pp 10151032 Tasker RR: Surgical treatment of the dystonias, in Gildenberg PL, Tasker RR (eds): Textbook of Stereotactic and Functional Neurosurgery. New York: McGraw-Hill, 1998, pp 1015–1032

    • Search Google Scholar
    • Export Citation
  • 42.

    Teo C: Functional stereotactic surgery of movement disorders in cerebral palsy, in Krauss JK, , Jankovic J, & Grossman RG (eds): Surgery for Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 410415 Teo C: Functional stereotactic surgery of movement disorders in cerebral palsy, in Krauss JK, Jankovic J, Grossman RG (eds): Surgery for Parkinson's Disease and Movement Disorders. Philadelphia: Lippincott Williams & Wilkins, 2001, pp 410–415

    • Search Google Scholar
    • Export Citation
  • 43.

    Tronnier VM, & Fogel W: Pallidal stimulation for generalized dystonia. Report of three cases. J Neurosurg 92:453456, 2000 Tronnier VM, Fogel W: Pallidal stimulation for generalized dystonia. Report of three cases. J Neurosurg 92:453–456, 2000

    • Search Google Scholar
    • Export Citation
  • 44.

    Trottenberg T, , Paul G, & Meissner W, et al: Pallidal and thalamic neurostimulation in severe tardive dystonia. J Neurol Neurosurg Psychiatry 70:557559, 2001 Trottenberg T, Paul G, Meissner W, et al: Pallidal and thalamic neurostimulation in severe tardive dystonia. J Neurol Neurosurg Psychiatry 70:557–559, 2001

    • Search Google Scholar
    • Export Citation
  • 45.

    Vercueil L, , Pollak P, & Fraix V, et al: Deep brain stimulation in the treatment of severe dystonia. J Neurol 248:695700, 2001 Vercueil L, Pollak P, Fraix V, et al: Deep brain stimulation in the treatment of severe dystonia. J Neurol 248:695–700, 2001

    • Search Google Scholar
    • Export Citation
  • 46.

    Vesper J, , Klostermann F, & Funk T, et al: Chronische Tiefenhirnstimulation des Globus pallidus internus bei Torsion dystonie. Zentralbl Neurochir 63:1822, 2002 Vesper J, Klostermann F, Funk T, et al: Chronische Tiefenhirnstimulation des Globus pallidus internus bei Torsion dystonie. Zentralbl Neurochir 63:18–22, 2002

    • Search Google Scholar
    • Export Citation
  • 47.

    Vitek JL: Pathophysiology of dystonia: a neuronal model. Mov Disord 17 (Suppl 3):S49S62, 2002 Vitek JL: Pathophysiology of dystonia: a neuronal model. Mov Disord 17 (Suppl 3):S49–S62, 2002

    • Search Google Scholar
    • Export Citation
  • 48.

    Vitek JL, , Chockkan V, & Zhang JY, et al: Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol 46:2235, 1999 Vitek JL, Chockkan V, Zhang JY, et al: Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol 46:22–35, 1999

    • Search Google Scholar
    • Export Citation
  • 49.

    Vitek JL, , Zhang J, & Evatt M, et al: GPi pallidotomy for dystonia: clinical outcome and neuronal activity. Adv Neurol 78:211219, 1998 Vitek JL, Zhang J, Evatt M, et al: GPi pallidotomy for dystonia: clinical outcome and neuronal activity. Adv Neurol 78:211–219, 1998

    • Search Google Scholar
    • Export Citation
  • 50.

    Volkmann J, & Benecke R: Deep brain stimulation for dystonia: patient selection and evaluation. Mov Disord 17 (Suppl 3):S112S115, 2002 Volkmann J, Benecke R: Deep brain stimulation for dystonia: patient selection and evaluation. Mov Disord 17 (Suppl 3):S112–S115, 2002

    • Search Google Scholar
    • Export Citation
  • 51.

    Yoshor D, , Hamilton WJ, & Ondo W, et al: Comparison of thalamotomy and pallidotomy for the treatment of dystonia. Neurosurgery 48:818826, 2001 Yoshor D, Hamilton WJ, Ondo W, et al: Comparison of thalamotomy and pallidotomy for the treatment of dystonia. Neurosurgery 48:818–826, 2001

    • Search Google Scholar
    • Export Citation

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