Deep brain stimulation of the globus pallidus internus versus the subthalamic nucleus in isolated dystonia

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OBJECTIVE

Surgical procedures involving deep brain stimulation (DBS) of the globus pallidus internus (GPi) or subthalamic nucleus (STN) are well-established treatments for isolated dystonia. However, selection of the best stimulation target remains a matter of debate. The authors’ objective was to compare the effectiveness of DBS of the GPi and the STN in patients with isolated dystonia.

METHODS

In this matched retrospective cohort study, the authors searched an institutional database for data on all patients with isolated dystonia who had undergone bilateral implantation of DBS electrodes in either the GPi or STN in the period from January 30, 2014, to June 30, 2017. Standardized assessments of dystonia and health-related quality of life using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and SF-36 were conducted before and at 1, 6, and 12 months after surgery. No patients were lost to the 6-month follow-up; 5 patients were lost to the 12-month follow-up.

RESULTS

Both GPi (14 patients) and STN (16 patients) stimulation produced significant improvement in dystonia and quality of life in all 30 patients found in the database search. At the 1-month follow-up, however, the percentage improvement in the BFMDRS total movement score was significantly (p = 0.01) larger after STN DBS (64%) than after GPi DBS (48%). At the 12-month follow-up, the percentage improvement in the axis subscore was significantly (p = 0.03) larger after GPi DBS (93%) than after STN DBS (83%). Also, the total amount of electrical energy delivered was significantly (p = 0.008) lower with STN DBS than with GPi DBS (124 ± 52 vs 192 ± 65 μJ, respectively).

CONCLUSIONS

The GPi and STN are both effective targets in alleviating dystonia and improving quality of life. However, GPi stimulation may be better for patients with axial symptoms. Moreover, STN stimulation may produce a larger clinical response within 1 month after surgery and may have a potential economic advantage in terms of lower battery consumption.

ABBREVIATIONS AC-PC = anterior commissure–posterior commissure; BFMDRS = Burke-Fahn-Marsden Dystonia Rating Scale; DBS = deep brain stimulation; GPi = globus pallidus internus; STN = subthalamic nucleus; TEED = total electrical energy delivered.

Supplementary Materials

  • Supplemental Table 1_JNS181927 (PDF 392 KB)
Article Information

Contributor Notes

Correspondence Dianyou Li: RuiJin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. ldy11483@rjh.com.cn.INCLUDE WHEN CITING Published online March 8, 2019; DOI: 10.3171/2018.12.JNS181927.

S.L. and Y.W. share first authorship of this work.

Disclosures Drs. D. Li and Zhang have received honoraria and travel expenses from the deep brain stimulation industry (Medtronic, PINS, and SceneRay); and Dr. Sun has received research support from PINS and SceneRay (donated devices).
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