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Unilateral pallidotomy as a potential rescue therapy for cervical dystonia after unsatisfactory selective peripheral denervation.
J Neurosurg Spine. 2020 Jun 26 [Online ahead of print]JN

Abstract

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.

Authors+Show Affiliations

1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and.1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and.1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and.No affiliation info available1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and.1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and. 2Research Group of Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium.1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and.1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and.1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and.1Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; and.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32590354

Citation

Lai, Yijie, et al. "Unilateral Pallidotomy as a Potential Rescue Therapy for Cervical Dystonia After Unsatisfactory Selective Peripheral Denervation." Journal of Neurosurgery. Spine, 2020, pp. 1-9.
Lai Y, Huang P, Zhang C, et al. Unilateral pallidotomy as a potential rescue therapy for cervical dystonia after unsatisfactory selective peripheral denervation. J Neurosurg Spine. 2020.
Lai, Y., Huang, P., Zhang, C., Hu, L., Deng, Z., Li, D., Sun, B., Liu, W., & Zhan, S. (2020). Unilateral pallidotomy as a potential rescue therapy for cervical dystonia after unsatisfactory selective peripheral denervation. Journal of Neurosurgery. Spine, 1-9. https://doi.org/10.3171/2020.4.SPINE191523
Lai Y, et al. Unilateral Pallidotomy as a Potential Rescue Therapy for Cervical Dystonia After Unsatisfactory Selective Peripheral Denervation. J Neurosurg Spine. 2020 Jun 26;1-9. PubMed PMID: 32590354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unilateral pallidotomy as a potential rescue therapy for cervical dystonia after unsatisfactory selective peripheral denervation. AU - Lai,Yijie, AU - Huang,Peng, AU - Zhang,Chencheng, AU - Hu,Liangyun, AU - ,, AU - Deng,Zhengdao, AU - Li,Dianyou, AU - Sun,Bomin, AU - Liu,Wei, AU - Zhan,Shikun, Y1 - 2020/06/26/ PY - 2019/12/19/received PY - 2020/04/08/accepted PY - 2020/6/27/entrez PY - 2020/6/27/pubmed PY - 2020/6/27/medline KW - AC-PC = anterior commissure–posterior commissure KW - BT = botulinum toxin KW - CD = cervical dystonia KW - CDQ-24 = 24-item Craniocervical Dystonia Questionnaire KW - DBS = deep brain stimulation KW - GPi = globus pallidum internus KW - SPD = selective peripheral denervation KW - TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale KW - cervical dystonia KW - functional neurosurgery KW - pallidotomy KW - selective peripheral denervation SP - 1 EP - 9 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine N2 - 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. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/32590354/Unilateral_pallidotomy_as_a_potential_rescue_therapy_for_cervical_dystonia_after_unsatisfactory_selective_peripheral_denervation L2 - https://thejns.org/doi/10.3171/2020.4.SPINE191523 DB - PRIME DP - Unbound Medicine ER -
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