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Deep Brain Stimulation for the Dystonias: Evidence, Knowledge Gaps, and Practical Considerations
René Reese1,2, Jens Volkmann2
1Department of Neurology Rostock University Medical Center Rostock Germany.
Movement Disorders Clinical Practice
|October 27, 2018
Summary
Deep brain stimulation (DBS) is effective for dystonia, particularly isolated forms. Distinguishing between isolated and combined dystonia is crucial for predicting patient response to globus pallidus internus DBS.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Globus pallidus internus deep brain stimulation (GPi-DBS) is a leading treatment for dystonia.
- Dystonia's heterogeneous presentation complicates GPi-DBS candidacy decisions.
Purpose of the Study:
- To review current concepts in surgical management of dystonia.
- To provide guidance on patient selection for GPi-DBS in dystonia.
Main Methods:
- PubMed database search for "deep brain stimulation" and "dystonia" articles.
- Recategorization of patient selection in prior studies using new dystonia classification.
- Synthesis of evidence, knowledge gaps, expert opinion, and clinical experience.
Main Results:
- GPi-DBS shows highest efficacy in isolated dystonia, regardless of cause.
- Combined dystonias generally show less benefit from GPi-DBS due to non-responsive associated symptoms (e.g., ataxia, hypotonia).
- Myoclonus is an exception, potentially responding to pallidal neurostimulation.
Conclusions:
- Clinical differentiation between isolated and combined dystonia predicts GPi-DBS treatment response.
- Recognizing dystonia subtypes is vital for guiding patients and selecting surgical candidates.
- This review aims to assist clinicians in advising patients on DBS therapy for dystonia.
Keywords:
deep brain stimulationdystoniaglobus pallidus internusnew dystonia classificationpatient selectionMore Related Videos
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