Treatment of intractable generalized dystonia by bilateral posteroventral pallidotomy--one-year results

Recent study has revealed that bilateral posteroventral pallidotomy (PVP) significantly improve dystonic movements and improve motor function of those patients with generalized dystonia (GD). However, there is only a limited number of patients who have been reported so far.

This study was conducted to evaluate the clinical efficacy of surgical treatment with bilateral PVP on patients with intractable GD. All the studied patients were regularly rated with standardized scales (Burke-Fahn-Marsden Evaluation Scale for Dystonia) for dystonic movement and living disability before and after surgery.

There were 18 patients, 8 males and 10 females with an average age of 24.8 years, included in the study. Postoperatively, there were slow, partial, but steady improvements of the dystonic movement and daily living function. Maximal effects were noted at the sixth month and the clinical benefits were sustained one year after the surgical treatment when there were statistically significant improvements in 13% of total dystonia movement score and 9% of the total disability score (p < 0.05). Upon further analysis, improvements of dystonic movements were statistically significant in the regions of mouth (50%), speech/swallowing (19%) and neck (43%), and daily living functions in speech (14%) and eating/swallowing (29%).

Bilateral posteroventral pallidotomy was only partially effective for the treatment of GD, and it produced clinical improvement in the dystonic movement limited to the craniocervical region. We therefore suggest that patients with GD should be carefully selected for the treatment of bilateral posteroventral pallidotomy, despite the surgery having a partially beneficial effect on this kind of movement.