Neuromodulation for dystonia: target and patient selection
Kelly A Mills1, Philip A Starr, Jill L Ostrem
1UCSF Department of Neurology, PADRECC, San Francisco VA Medical Center, UCSF Box 1838, 1635 Divisadero Street, Suite 520, San Francisco, CA 94143-1838, USA.
Neurosurgery Clinics of North America
|November 23, 2013
Summary
Deep brain stimulation (DBS) offers treatment for refractory dystonia. Patient factors and target selection, including the globus pallidus internus, are crucial for successful outcomes in managing this movement disorder.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Dystonia treatment often involves oral medications or botulinum toxin injections.
- Deep brain stimulation (DBS) is an option for patients refractory to these treatments.
Purpose of the Study:
- To discuss patient-related factors influencing expectations for DBS in dystonia.
- To highlight target selection as a key emerging issue in DBS for dystonia.
Main Methods:
- Review of current literature and clinical considerations for DBS in dystonia.
- Analysis of factors impacting surgical outcomes and target selection.
Main Results:
- Patient factors (dystonia type, genetics, age, disease duration, deformities) and premorbid conditions (psychiatric, cognitive) influence DBS outcomes.
- Globus pallidus internus is an established target, but others show promise.
Conclusions:
- Personalized patient assessment is vital for setting expectations in DBS for dystonia.
- Exploring alternative brain targets beyond the globus pallidus internus is warranted for optimizing DBS therapy.
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