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Use of pallidal deep brain stimulation in postinfarct hemidystonia
Jennifer Witt1, Phillip A Starr, Jill L Ostrem
1Department of Neurology, University of California, San Francisco and Center for Movement Disorders, San Francisco, CA, USA. je.landes@gmail.com
Insights
Deep brain stimulation (DBS) for stroke-induced hemidystonia showed subjective improvement but no measurable motor gains in a small case series. Further research is needed for secondary dystonia treatments.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Limited data exists on deep brain stimulation (DBS) for treating dystonia secondary to stroke.
- This study focuses on three patients with striatal infarcts who developed hemidystonia.
Observation:
- Three patients with striatal infarcts and hemidystonia underwent unilateral globus pallidus interna DBS.
- Outcomes were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) at 3, 6, and 12+ months post-surgery.
Findings:
- All patients reported subjective symptom improvement after DBS.
- No patient demonstrated a measurable improvement in BFMDRS movement scores at one year or longer.
- Pallidal DBS appears to offer limited objective benefit for secondary dystonia.
Implications:
- Findings align with previous studies suggesting limited efficacy of pallidal DBS in secondary dystonia.
- Future research should explore predictive factors for DBS success and develop sensitive assessment tools for secondary dystonias.
- Investigating alternative brain targets for stimulation is warranted.
Background/Aims:
Reports of outcomes in treating dystonia secondary to stroke with deep brain stimulation (DBS) are limited. We report our experience with 3 patients, all with infarcts involving the striatum, who developed hemidystonia and were treated with unilateral globus pallidus interna DBS.
Methods:
Case series describing characteristics and outcomes based on the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores before and after DBS at 3, 6 and at least 12 months.
Results:
All patients reported subjective improvements after surgery. At 1 year or more after surgery, none of the 3 patients displayed a measureable improvement in the BFMDRS movement score.
Conclusion:
Our findings are consistent with previous reports of limited benefits from pallidal DBS in secondary dystonia. Future work should focus on predictive factors for DBS outcomes and the development of more sensitive assessment tools specifically for secondary dystonias as well as the exploration of alternative brain targets for stimulation.
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