Subthalamic nucleus deep brain stimulation for severe idiopathic dystonia: impact on severity, neuropsychological status, and quality of life

Restricted access

Object

Medically refractory dystonia has recently been treated using deep brain stimulation (DBS) targeting the globus pallidus internus (GPI). Outcomes have varied depending on the features of the dystonia. There has been limited literature regarding outcomes for refractory dystonia following DBS of the subthalamic nucleus (STN).

Methods

Four patients with medically refractory, predominantly cervical dystonia underwent STN DBS. Intraoperative assessments with the patients in a state of general anesthesia were performed to determine the extent of fixed deformities that might predict outcome. Patients were rated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) preoperatively and 3 and 12 months following surgery by a rater blinded to the study. Mean changes and standard errors of the mean in scores were calculated for each subscore of the two scales. Scores were also analyzed using analysis of variance and probability values were generated. Neuropsychological assessments and quality of life ratings using the 36-Item Short Form Health Survey (SF-36) were evaluated longitudinally.

Results

Significant improvements were seen in motor (p = 0.04), disability (p = 0.02), and total TWSTRS scores (p = 0.03). Better outcomes were seen in those patients who did not have fixed deformities. There was marked improvement in the mental component score of the SF-36. Neuropsychological function was not definitively impacted as a result of the surgery.

Conclusions

Deep brain stimulation of the STN is a novel target for dystonia and may be an alternative to GPI DBS. Further studies need to be performed to confirm these conclusions and to determine optimal candidates and stimulation parameters.

Abbreviations used in this paper:BFMDRS = Burke-Fahn-Marsden Dystonia Rating Scale; DBS = deep brain stimulation; GPI = globus pallidus internus; MCS = Mental Component Summary; MR = magnetic resonance; PCS = Physical Component Summary; QOL = quality of life; ROM = range of motion; SF-36 = 36-Item Short Form Health Survey; STN = subthalamic nucleus; TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale.
Article Information

Contributor Notes

Address reprint requests to: Galit Kleiner-Fisman, M.D., Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, McL-7, Toronto, Ontario, M5T 2S8 Canada. email: gkleinerfisman@yahoo.com.
Headings
References
  • 1

    Burke REFahn SMarsden CDBressman SBMoskowitz CFriedman J: Validity and reliability of a rating scale for the primary torsion dystonias. Neurology 35:73771985

    • Search Google Scholar
    • Export Citation
  • 2

    Castelnau PCif LValente EMVayssiere NHemm SGannau A: Pallidal stimulation improves pantothenate kinase-associated neurodegeneration. Ann Neurol 57:7387412005

    • Search Google Scholar
    • Export Citation
  • 3

    Chou KLHurtig HIJaggi JLBaltuch GH: Bilateral subthalamic nucleus deep brain stimulation in a patient with cervical dystonia and essential tremor. Mov Disord 20:3773802005

    • Search Google Scholar
    • Export Citation
  • 4

    Comella CLLeurgans SWuu JStebbins GTChmura T: Rating scales for dystonia: a multicenter assessment. Mov Disord 18:3033122003

    • Search Google Scholar
    • Export Citation
  • 5

    Coubes PCif LEl Fertit HHemm SVayssiere NSerrat S: Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results. J Neurosurg 101:1891952004

    • Search Google Scholar
    • Export Citation
  • 6

    Detante OVercueil LKrack PChabardes SBenabid ALPollack P: Off-period dystonia in Parkinson's disease but not generalized dystonia is improved by high-frequency stimulation of the subthalamic nucleus. Adv Neurol 94:3093142004

    • Search Google Scholar
    • Export Citation
  • 7

    Duane DDVermilion KJ: Cognition and affect in patients with cervical dystonia with and without tremor. Adv Neurol 94:1791892004

  • 8

    Eltahawy HASaint-Cyr JPoon YYMoro ELang AELozano AM: Pallidal deep brain stimulation in cervical dystonia: clinical outcome in four cases. Can J Neurol Sci 31:3283322004

    • Search Google Scholar
    • Export Citation
  • 9

    Fahn SBressman SBMarsden CD: Classification of dystonia. Adv Neurol 78:1101998

  • 10

    Franzini AMarras CFerroli PZorzi GBugiani ORomito L: Long-term high-frequency bilateral pallidal stimulation for neuroleptic-induced tardive dystonia. Report of two cases. J Neurosurg 102:7217252005

    • Search Google Scholar
    • Export Citation
  • 11

    Hallett M: Dystonia: abnormal movements result from loss of inhibition. Adv Neurol 94:192004

  • 12

    Hinse PLeplow BHumbert TLamparter UJunge AEmskotter T: Impairment of visuospatial function in idiopathic spasmodic torticollis. J Neurol 243:29331996

    • Search Google Scholar
    • Export Citation
  • 13

    Houser MWaltz T: Meige syndrome and pallidal deep brain stimulation. Mov Disord 20:120312052005

  • 14

    Jaggi JLUmemura AHurtig HISiderowf ADColcher AStern MB: Bilateral stimulation of the subthalamic nucleus in Par-kinson's disease: surgical efficacy and prediction of outcome. Stereotact Funct Neurosurg 82:1041142004

    • Search Google Scholar
    • Export Citation
  • 15

    Jahanshahi MRowe JFuller R: Cognitive executive function in dystonia. Mov Disord 18:147014812003

  • 16

    Konrad CVollmer-Haase JAnneken KKnecht S: Orthopedic and neurological complications of cervical dystonia—review of the literature. Acta Neurol Scand 109:3693732004

    • Search Google Scholar
    • Export Citation
  • 17

    Krauss JKLoher TJWeigel RCapelle HHWeber SBurgunder JM: Chronic stimulation of the globus pallidus internus for treatment of non-dYT1 generalized dystonia and choreoathetosis: 2-year follow up. J Neurosurg 98:7857922003

    • Search Google Scholar
    • Export Citation
  • 18

    Lyons KEPahwa R: Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease. J Neurosurg 104:5025052006

    • Search Google Scholar
    • Export Citation
  • 19

    Schrag ATrimble MQuinn NBhatia K: The syndrome of fixed dystonia: an evaluation of 103 patients. Brain 127:236023722004

  • 20

    Scott RBGregory RWilson JBanks STurner AParkin S: Executive cognitive deficits in primary dystonia. Mov Disord 18:5395502003

    • Search Google Scholar
    • Export Citation
  • 21

    Sun BLi DSun C: Target selection for primary dystonia deep brain stimulation: Gpi or STN. Proceedings from the American Society for Stereotactic and Functional Neurosurgery Quadrennial MeetingMay 18–21New York2003. (Abstract)

    • Search Google Scholar
    • Export Citation
  • 22

    Tarsy D: Comparison of clinical rating scales in treatment of cervical dystonia with botulinum toxin. Mov Disord 12:1001021997

  • 23

    Trottenberg TVolkmann JDeuschl GKuhn AASchneider GHMuller J: Treatment of severe tardive dystonia with pallidal deep brain stimulation. Neurology 64:3443462005

    • Search Google Scholar
    • Export Citation
  • 24

    Ware JEKosinski M: Interpreting SF-36 summary health measures: a response. Qual Life Res 10:4054202001

  • 25

    Ware JE JrKosinski MGandek B: SF-36 Health Survey: Manual and Interpretation Guide Lincoln, RIQualityMetric2000

  • 26

    Yianni JBain PGGregory RPNandi DJoint CScott RB: Post-operative progress of dystonia patients following globus pallidus internus deep brain stimulation. Eur J Neurol 10:2392472003

    • Search Google Scholar
    • Export Citation
  • 27

    Zorzi GMarras CNardocci NFranzini AChiapparini LMaccagnano E: Stimulation of the globus pallidus internus for childhood-onset dystonia. Mov Disord 20:119412002005

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 324 321 40
Full Text Views 193 99 2
PDF Downloads 114 59 0
EPUB Downloads 0 0 0
PubMed
Google Scholar