Bilateral Pallidotomy for Dystonia: A Systematic Review

Area of Science:

• Neurosurgery
• Neurology
• Movement Disorders

Background:

• Stereotactic bilateral globus pallidus (GPi) lesioning was an early surgical treatment for dystonia.
• Deep brain stimulation (DBS) has largely replaced pallidotomy, but not all dystonia patients are candidates for DBS.
• Bilateral pallidotomy remains a relevant consideration for specific patient groups.

Purpose of the Study:

• To systematically review the efficacy, safety, and sustainability of bilateral pallidotomy.
• To evaluate outcomes using individual patient data (IPD) for a comprehensive analysis.
• To assess bilateral pallidotomy as an alternative surgical treatment for dystonia.

Main Methods:

• Systematic review of individual patient data (IPD) following PRISMA guidelines.
• Searched Medline, Embase, Web of Science, and Cochrane Library for relevant studies up to May 2020.
• Analyzed data from 100 patients across 33 articles, collecting IPD where available.

Main Results:

• Bilateral pallidotomy showed a clinically relevant improvement (>20%) in 79% of 53 patients assessed.
• Adverse events occurred in 20% of patients, with 8% experiencing permanent adverse events.
• Status dystonicus (SD) resolved in most patients (23/25), though 7 experienced relapse.

Conclusions:

• Bilateral pallidotomy is an effective and relatively safe procedure for specific dystonia types, particularly medication-refractory status dystonicus.
• Despite potential publication bias, it represents a reasonable alternative to DBS for selected dystonia patients.
• The sustainability of outcomes requires further investigation beyond the median 12-month follow-up.