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Subthalamic nucleus deep brain stimulation in primary cervical dystonia.
Neurology. 2011 Mar 08; 76(10):870-8.Neur

Abstract

OBJECTIVES

The globus pallidus internus (GPi) has been the primary target for deep brain stimulation (DBS) to treat severe medication-refractory dystonia. Some patients with primary cervical or segmental dystonia develop subtle bradykinesia occurring in previously nondystonic body regions during GPi DBS. Subthalamic nucleus (STN) DBS may provide an alternative target choice for treating dystonia, but has only been described in a few short reports, without blinded rating scales, statistical analysis, or detailed neuropsychological studies.

METHODS

In this prospective pilot study, we analyzed the effect of bilateral STN DBS on safety, efficacy, quality of life, and neuropsychological functioning in 9 patients with medically refractory primary cervical dystonia. Severity of dystonia was scored by a blinded rater (unaware of the patient's preoperative or postoperative status) using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) preoperatively and 3, 6, and 12 months postsurgery. Lead location, medications, and adverse events were also measured.

RESULTS

STN DBS was well-tolerated with no serious adverse effects. The TWSTRS total score improved (p < 0.001) from a mean (±SEM) of 53.1 (±2.57), to 19.6 (±5.48) at 12 months. Quality of life measures were also improved. STN DBS induced no consistent neuropsychological deficits. Several patients reported depression in the study and 3 had marked weight gain. No patients developed bradykinetic side effects from stimulation, but all patients developed transient dyskinetic movements during stimulation.

CONCLUSIONS

This prospective study showed that bilateral STN DBS resulted in improvement in dystonia and suggests that STN DBS may be an alternative to GPi DBS for treating primary cervical dystonia.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that bilateral subthalamic nucleus deep brain stimulation results in significant improvement in cervical dystonia without bradykinetic side effects.

Authors+Show Affiliations

Department of Neurology, Surgical Movement Disorders, 1635 Divisadero Street, Fifth Floor, Suites 520-530, San Francisco, CA 94115, USA. jill.ostrem@ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21383323

Citation

Ostrem, J L., et al. "Subthalamic Nucleus Deep Brain Stimulation in Primary Cervical Dystonia." Neurology, vol. 76, no. 10, 2011, pp. 870-8.
Ostrem JL, Racine CA, Glass GA, et al. Subthalamic nucleus deep brain stimulation in primary cervical dystonia. Neurology. 2011;76(10):870-8.
Ostrem, J. L., Racine, C. A., Glass, G. A., Grace, J. K., Volz, M. M., Heath, S. L., & Starr, P. A. (2011). Subthalamic nucleus deep brain stimulation in primary cervical dystonia. Neurology, 76(10), 870-8. https://doi.org/10.1212/WNL.0b013e31820f2e4f
Ostrem JL, et al. Subthalamic Nucleus Deep Brain Stimulation in Primary Cervical Dystonia. Neurology. 2011 Mar 8;76(10):870-8. PubMed PMID: 21383323.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Subthalamic nucleus deep brain stimulation in primary cervical dystonia. AU - Ostrem,J L, AU - Racine,C A, AU - Glass,G A, AU - Grace,J K, AU - Volz,M M, AU - Heath,S L, AU - Starr,P A, PY - 2011/3/9/entrez PY - 2011/3/9/pubmed PY - 2011/5/7/medline SP - 870 EP - 8 JF - Neurology JO - Neurology VL - 76 IS - 10 N2 - OBJECTIVES: The globus pallidus internus (GPi) has been the primary target for deep brain stimulation (DBS) to treat severe medication-refractory dystonia. Some patients with primary cervical or segmental dystonia develop subtle bradykinesia occurring in previously nondystonic body regions during GPi DBS. Subthalamic nucleus (STN) DBS may provide an alternative target choice for treating dystonia, but has only been described in a few short reports, without blinded rating scales, statistical analysis, or detailed neuropsychological studies. METHODS: In this prospective pilot study, we analyzed the effect of bilateral STN DBS on safety, efficacy, quality of life, and neuropsychological functioning in 9 patients with medically refractory primary cervical dystonia. Severity of dystonia was scored by a blinded rater (unaware of the patient's preoperative or postoperative status) using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) preoperatively and 3, 6, and 12 months postsurgery. Lead location, medications, and adverse events were also measured. RESULTS: STN DBS was well-tolerated with no serious adverse effects. The TWSTRS total score improved (p < 0.001) from a mean (±SEM) of 53.1 (±2.57), to 19.6 (±5.48) at 12 months. Quality of life measures were also improved. STN DBS induced no consistent neuropsychological deficits. Several patients reported depression in the study and 3 had marked weight gain. No patients developed bradykinetic side effects from stimulation, but all patients developed transient dyskinetic movements during stimulation. CONCLUSIONS: This prospective study showed that bilateral STN DBS resulted in improvement in dystonia and suggests that STN DBS may be an alternative to GPi DBS for treating primary cervical dystonia. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that bilateral subthalamic nucleus deep brain stimulation results in significant improvement in cervical dystonia without bradykinetic side effects. SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/21383323/Subthalamic_nucleus_deep_brain_stimulation_in_primary_cervical_dystonia_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&amp;pmid=21383323 DB - PRIME DP - Unbound Medicine ER -