Deep brain stimulation in the treatment of dyskinesia and dystonia

Hiroki Toda M.D., Ph.D., Clement Hamani M.D., Ph.D., and Andres Lozano M.D., Ph.D., F.R.C.S.(C)
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  • Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Cananda
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Deep brain stimulation (DBS) has become a mainstay of treatment for patients with movement disorders. This modality is directed at modulating pathological activity within basal ganglia output structures by stimulating some of their nuclei, such as the subthalamic nucleus (STN) and the globus pallidus internus (GPi), without making permanent lesions. With the accumulation of experience, indications for the use of DBS have become clearer and the effectiveness and limitations of this form of therapy in different clinical conditions have been better appreciated. In this review the authors discuss the efficacy of DBS in the treatment of dystonia and levodopa-induced dyskinesias. The use of DBS of the STN and GPi is very effective for the treatment of movement disorders induced by levodopa. The relative benefits of using the GPi as opposed to the STN as a target are still being investigated. Bilateral GPi stimulation is gaining importance in the therapeutic armamentarium for the treatment of dystonia. The DYT1 forms of generalized dystonia and cervical dystonias respond to DBS better than secondary dystonia does. Discrimination between the diverse forms of dystonia and a better understanding of the pathophysiological features of this condition will serve as a platform for improved outcomes.

Abbreviations used in this paper:

DBS = deep brain stimulation; GP = globus pallidus; GPe = GP externus; GPi = GP internus; PD = Parkinson disease; STN = subthalamic nucleus.

Deep brain stimulation (DBS) has become a mainstay of treatment for patients with movement disorders. This modality is directed at modulating pathological activity within basal ganglia output structures by stimulating some of their nuclei, such as the subthalamic nucleus (STN) and the globus pallidus internus (GPi), without making permanent lesions. With the accumulation of experience, indications for the use of DBS have become clearer and the effectiveness and limitations of this form of therapy in different clinical conditions have been better appreciated. In this review the authors discuss the efficacy of DBS in the treatment of dystonia and levodopa-induced dyskinesias. The use of DBS of the STN and GPi is very effective for the treatment of movement disorders induced by levodopa. The relative benefits of using the GPi as opposed to the STN as a target are still being investigated. Bilateral GPi stimulation is gaining importance in the therapeutic armamentarium for the treatment of dystonia. The DYT1 forms of generalized dystonia and cervical dystonias respond to DBS better than secondary dystonia does. Discrimination between the diverse forms of dystonia and a better understanding of the pathophysiological features of this condition will serve as a platform for improved outcomes.

Abbreviations used in this paper:

DBS = deep brain stimulation; GP = globus pallidus; GPe = GP externus; GPi = GP internus; PD = Parkinson disease; STN = subthalamic nucleus.

Contributor Notes

Address reprint requests to: Andres Lozano, M.D., Ph.D., F.R.C.S.(C), Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario M5T 2S8 Canada. email: lozano@uhnres.utoronto.ca.

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