Unilateral pallidotomy as a potential rescue therapy for cervical dystonia after unsatisfactory selective peripheral denervation

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  • 1 Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and
  • 2 Research Group of Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium
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OBJECTIVE

Selective peripheral denervation (SPD) is a widely accepted surgery for medically refractory cervical dystonia (CD), but when SPD has failed, the available approaches are limited. The authors investigated the results from a cohort of CD patients treated with unilateral pallidotomy after unsatisfactory SPD.

METHODS

The authors retrospectively analyzed patients with primary CD who underwent unilateral pallidotomy after SPD between April 2007 and August 2019. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was used to evaluate symptom severity before surgery, 7 days postsurgery, 3 months postsurgery, and at the last follow-up. TWSTRS subscores for disability and pain and the 24-item Craniocervical Dystonia Questionnaire (CDQ-24) were used to assess quality of life.

RESULTS

At a mean final follow-up of 5 years, TWSTRS severity subscores and total scores were significantly improved (n = 12, mean improvement 57.3% and 62.3%, respectively, p = 0.0022 and p = 0.0022), and 8 of 12 patients (66.7%) were characterized as responders (improvement ≥ 25%). Patients with rotation symptoms before pallidotomy showed greater improvement in TWSTRS severity subscores than those who did not (p = 0.049). The most common adverse event was mild upper-limb weakness (n = 3). Patients’ quality of life was also improved.

CONCLUSIONS

Unilateral pallidotomy seems to offer an effective and safe option for patients with CD who have otherwise experienced limited benefits from SPD.

ABBREVIATIONS AC-PC = anterior commissure–posterior commissure; BT = botulinum toxin; CD = cervical dystonia; CDQ-24 = 24-item Craniocervical Dystonia Questionnaire; DBS = deep brain stimulation; GPi = globus pallidum internus; SPD = selective peripheral denervation; TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale.

Supplementary Materials

    • Table S1 (PDF 419 KB)

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Contributor Notes

Correspondence Shikun Zhan: Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. shikun_zhan@163.com.

INCLUDE WHEN CITING Published online June 26, 2020; DOI: 10.3171/2020.4.SPINE191523.

Y.L. and P.H. contributed equally to this work and share first authorship.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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