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Selective peripheral denervation: comparison with pallidal stimulation and literature review
Maria Fiorella Contarino1, Pepijn Van Den Munckhof, Marina A J Tijssen
1Department of Neurology/Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, m.f.contarino@amc.uva.nl.
Deep brain stimulation of the globus pallidus (GPi-DBS) offers superior outcomes for cervical dystonia compared to selective peripheral denervation (SPD). GPi-DBS provides greater benefit, making it the preferred surgical option for non-responders to botulinum toxin.
Area of Science:
- Neurosurgery
- Neurology
- Movement Disorders
Background:
- Cervical dystonia (CD) is a movement disorder characterized by involuntary neck muscle contractions.
- Patients refractory to botulinum toxin injections are candidates for surgical interventions.
- Selective peripheral denervation (SPD) and globus pallidus deep brain stimulation (GPi-DBS) are surgical options for CD.
Purpose of the Study:
- To compare the long-term outcomes of SPD and GPi-DBS in treating cervical dystonia.
- To evaluate the efficacy and safety of these surgical procedures.
- To provide a literature review on the comparative effectiveness of SPD and GPi-DBS.
Main Methods:
- A retrospective study comparing 20 patients who underwent SPD and 15 patients who underwent GPi-DBS.
- Assessment of surgical outcomes using the Tsui scale, visual analogue scale, and Toronto Western Spasmodic Torticollis Rating Scale.
- Analysis of combined global surgical outcomes, including "bad", "fair-to-good", and "marked" improvement categories.
Main Results:
- GPi-DBS showed significantly higher rates of "marked" improvement (60%) compared to SPD (5%) (p < 0.001).
- Patients undergoing GPi-DBS experienced greater improvements in visual analogue scale, global outcome score, and Tsui score (p < 0.002).
- While both procedures had side effects (75% for SPD, 60% for GPi-DBS), GPi-DBS demonstrated superior efficacy.
Conclusions:
- GPi-DBS is the preferred surgical treatment for cervical dystonia due to superior efficacy over SPD.
- GPi-DBS offers significant benefits even in cases of SPD failure.
- While GPi-DBS may have more severe potential complications, its greater therapeutic benefit justifies its use.
