Deep Brain Stimulation of the Globus Pallidus Internus for Secondary Dystonia: Clinical Cases and Systematic Review of the Literature Regarding the Effectiveness of Globus Pallidus Internus versus Subthalamic Nucleus

S. Ozturk*, Y. Temel, D. Aygun, E. Kocabicak

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

1 Citation (Web of Science)
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Abstract

OBJECTIVE: Deep brain stimulation (DBS) is a frequently applied therapy in primary dystonia. For secondary dystonia, the effects can be less favorable. We share our long-term findings in 9 patients with severe secondary dystonia and discuss these findings in the light of the literature. METHODS: Patients who had undergone globus pallidus internus (GPi)-DBS for secondary dystonia were included. Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores, clinical improvement rates, follow-up periods, stim lation parameters and the need for internal pulse generator replacements were analyzed. The PubMed and Google Scholar databases were searched for articles describing GPiDBS and subthalamic nucleus (STN)-DBS only for secondary dystonia cases. Keywords were "dystonia," "deep brain stimulation," "GPi," "dystonia," "deep brain stimulation," and "STN." RESULTS: A total of 9 secondary dystonia patients (5 male, 4 female) had undergone GPi-DBS with microelectrode recording in our units. The mean follow-up period was 29 months. The average BFMDRS score was 58.2 before the surgery, whereas the mean value was 36.5 at the last follow-up of the patients (mean improvement, 39%; minimum, 9%; maximum, 63%). In the literature review, we identified 264 GPi-DBS cases (mean follow-up, 19 months) in 72 different articles about secondary dystonia. The mean BFMDRS improvement rate was 52%. In 146 secondary dystonia cases, reported in 19 articles, STN-DBS was performed. The average follow-up period was 20 months and the improvement in BFMDRS score was 66%. CONCLUSIONS: Although GPi-DBS has favorable longterm efficacy and safety in the treatment of patients with secondary dystonia, STN seems a promising target for stimu lation in patients with secondary dystonia. Further studies including a large number of patients, longer follow-up periods, and more homogenous patients are necessary to establish the optimal target for DBS in the management of secondary dystonias.
Original languageEnglish
Pages (from-to)E495-E508
Number of pages14
JournalWorld Neurosurgery
Volume154
DOIs
Publication statusPublished - 1 Oct 2021

Keywords

  • -Deep brain stimulation
  • Dystonia
  • -Globus pallidus internus
  • Subthalamic nucleus
  • Target selection
  • KINASE-ASSOCIATED NEURODEGENERATION
  • LONG-TERM BENEFIT
  • GENERALIZED DYSTONIA
  • BASAL GANGLIA
  • FOLLOW-UP
  • MICROELECTRODE RECORDINGS
  • NEURONAL-ACTIVITY
  • TARDIVE DYSTONIA
  • CEREBRAL-PALSY
  • MEIGE SYNDROME

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