Deep brain stimulation for dystonia in adults. Overview and developments

Area of Science:

• Neurosurgery
• Neurology
• Movement Disorders

Background:

• Functional neurosurgery is experiencing a resurgence for Parkinson's disease, prompting interest in treating other medically refractory movement disorders.
• Deep brain stimulation (DBS) is a relatively new treatment for dystonia, offering an alternative to ablative lesioning techniques.

Purpose of the Study:

• To review current data on pallidal and thalamic DBS for various dystonic syndromes.
• To assess the efficacy and limitations of DBS in different types of dystonia.

Main Methods:

• Review of available data on pallidal and thalamic DBS for dystonia.
• Analysis of outcomes based on dystonia type, patient demographics, and follow-up duration.

Main Results:

• Posteroventral medial globus pallidus internus (GPi) is the primary target for DBS in dystonia.
• DBS shows significant benefits in primary genetic generalized/segmental dystonia, myoclonic dystonia, and complex cervical dystonia.
• Outcomes are variable in secondary dystonia and choreoathetosis associated with cerebral palsy; thalamic DBS has limited data but shows promise in specific cases.

Conclusions:

• Pallidal DBS is effective for complex cervical dystonia and DYT1-positive dystonia, with sustained benefits observed.
• DBS offers bilateral, low-morbidity surgery compared to lesioning, with potential for delayed improvement in tonic movements.
• Further research with longer follow-up periods and new technologies is needed to optimize DBS for diverse dystonic conditions.