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Deep Brain Stimulation Versus Peripheral Denervation for Cervical Dystonia: A Systematic Review and Meta-Analysis.
World Neurosurg. 2019 Feb; 122:e940-e946.WN

Abstract

BACKGROUND

Cervical dystonia is a disabling medical condition that drastically decreases quality of life. Surgical treatment consists of peripheral nerve denervation procedures with or without myectomies or deep brain stimulation (DBS). The current objective was to compare the efficacy of peripheral denervation versus DBS in improving the severity of cervical dystonia through a systematic review and meta-analysis.

METHODS

A search of PubMed, MEDLINE, EMBASE, and Web of Science electronic databases was conducted in accordance with PRISMA guidelines. Preoperative and postoperative Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total scores were used to generate standardized mean differences and 95% confidence intervals (CIs), which were combined in a random-effects model. Both mean percentage and absolute reduction in TWSTRS scores were calculated. Absolute reduction was used for forest plots.

RESULTS

Eighteen studies met the inclusion criteria, comprising 870 patients with 180 (21%) undergoing DBS and 690 (79%) undergoing peripheral denervation procedures. The mean follow-up time was 31.5 months (range, 12-38 months). In assessing the efficacy of each intervention, forest plots revealed significant absolute reduction in total postoperative TWSTRS scores for both peripheral denervation (standardized mean difference 1.54; 95% CI 1.42-1.66) and DBS (standardized mean difference 2.07; 95% CI 1.43-2.71). On subgroup analysis, DBS therapy was significantly associated with improvement in postoperative TWSTRS severity (standardized mean difference 2.08; 95% CI 1.66-2.50) and disability (standardized mean difference 2.12; 95% CI 1.57-2.68) but not pain (standardized mean difference 1.18; 95% CI 0.80-1.55).

CONCLUSIONS

Both peripheral denervation and DBS are associated with a significant reduction in absolute TWSTRS total score, with no significant difference in the magnitude of reduction observed between the 2 treatments. Further comparative data are needed to better evaluate the long-term results of both interventions.

Authors+Show Affiliations

Department of Neurosurgery, Vanderbilt University Medical Center School, Nashville, Tennessee, USA.Department of Surgery, Section of Plastic Surgery, University of Michigan, Ann Arbor, Michigan.Department of Neurosurgery, Vanderbilt University Medical Center School, Nashville, Tennessee, USA.Department of Neurosurgery, Stanford University, Stanford, California, USA.Department of Neurosurgery, Vanderbilt University Medical Center School, Nashville, Tennessee, USA. Electronic address: scott.zuckerman@vumc.org.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

30419402

Citation

Ravindran, Krishnan, et al. "Deep Brain Stimulation Versus Peripheral Denervation for Cervical Dystonia: a Systematic Review and Meta-Analysis." World Neurosurgery, vol. 122, 2019, pp. e940-e946.
Ravindran K, Ganesh Kumar N, Englot DJ, et al. Deep Brain Stimulation Versus Peripheral Denervation for Cervical Dystonia: A Systematic Review and Meta-Analysis. World Neurosurg. 2019;122:e940-e946.
Ravindran, K., Ganesh Kumar, N., Englot, D. J., Wilson, T. J., & Zuckerman, S. L. (2019). Deep Brain Stimulation Versus Peripheral Denervation for Cervical Dystonia: A Systematic Review and Meta-Analysis. World Neurosurgery, 122, e940-e946. https://doi.org/10.1016/j.wneu.2018.10.178
Ravindran K, et al. Deep Brain Stimulation Versus Peripheral Denervation for Cervical Dystonia: a Systematic Review and Meta-Analysis. World Neurosurg. 2019;122:e940-e946. PubMed PMID: 30419402.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep Brain Stimulation Versus Peripheral Denervation for Cervical Dystonia: A Systematic Review and Meta-Analysis. AU - Ravindran,Krishnan, AU - Ganesh Kumar,Nishant, AU - Englot,Dario J, AU - Wilson,Thomas J, AU - Zuckerman,Scott L, Y1 - 2018/11/10/ PY - 2018/09/25/received PY - 2018/10/26/accepted PY - 2018/11/13/pubmed PY - 2019/2/23/medline PY - 2018/11/13/entrez KW - Cervical dystonia KW - Deep brain stimulation KW - Selective peripheral degeneration SP - e940 EP - e946 JF - World neurosurgery JO - World Neurosurg VL - 122 N2 - BACKGROUND: Cervical dystonia is a disabling medical condition that drastically decreases quality of life. Surgical treatment consists of peripheral nerve denervation procedures with or without myectomies or deep brain stimulation (DBS). The current objective was to compare the efficacy of peripheral denervation versus DBS in improving the severity of cervical dystonia through a systematic review and meta-analysis. METHODS: A search of PubMed, MEDLINE, EMBASE, and Web of Science electronic databases was conducted in accordance with PRISMA guidelines. Preoperative and postoperative Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total scores were used to generate standardized mean differences and 95% confidence intervals (CIs), which were combined in a random-effects model. Both mean percentage and absolute reduction in TWSTRS scores were calculated. Absolute reduction was used for forest plots. RESULTS: Eighteen studies met the inclusion criteria, comprising 870 patients with 180 (21%) undergoing DBS and 690 (79%) undergoing peripheral denervation procedures. The mean follow-up time was 31.5 months (range, 12-38 months). In assessing the efficacy of each intervention, forest plots revealed significant absolute reduction in total postoperative TWSTRS scores for both peripheral denervation (standardized mean difference 1.54; 95% CI 1.42-1.66) and DBS (standardized mean difference 2.07; 95% CI 1.43-2.71). On subgroup analysis, DBS therapy was significantly associated with improvement in postoperative TWSTRS severity (standardized mean difference 2.08; 95% CI 1.66-2.50) and disability (standardized mean difference 2.12; 95% CI 1.57-2.68) but not pain (standardized mean difference 1.18; 95% CI 0.80-1.55). CONCLUSIONS: Both peripheral denervation and DBS are associated with a significant reduction in absolute TWSTRS total score, with no significant difference in the magnitude of reduction observed between the 2 treatments. Further comparative data are needed to better evaluate the long-term results of both interventions. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/30419402/Deep_Brain_Stimulation_Versus_Peripheral_Denervation_for_Cervical_Dystonia:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1878-8750(18)32485-9 DB - PRIME DP - Unbound Medicine ER -