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Estimulación cerebral profunda palidal bilateral frente a palliidotomía bilateral en el manejo de la distonía

Hesham Radwan¹, Ahmed Kamel Basha¹, Mazen T Alkarras¹

¹Neurosurgery Department, Faculty of Medicine, Ain Shams University, Abbasya, Cairo, Egypt.

Clinical neurology and neurosurgery

|February 28, 2026

Abstracto

Background:

Post-anoxic acquired generalized dystonia is a rare and severely disabling condition in which medical therapy is often ineffective. Pallidal deep brain stimulation (DBS) is widely used for generalized dystonia; however, its efficacy in acquired dystonia is less well established, and access may be limited in resource-constrained settings. Bilateral posteroventral pallidotomy (PVP) represents a potential alternative, but comparative data between the two approaches in post-anoxic dystonia are lacking.

Objective:

To compare clinical outcomes and safety profiles of bilateral globus pallidus internus deep brain stimulation (GPi-DBS) and bilateral simultaneous posteroventral pallidotomy (PVP) in patients with post-anoxic acquired generalized dystonia.

Methods:

A retrospective cohort study was conducted including patients with post-anoxic generalized dystonia who underwent bilateral GPi-DBS or bilateral simultaneous PVP between June 2014 and December 2025. Outcomes were assessed using the Burke-Fahn-Marsden Movement Scale (BFM-MS) and Disability Scale (BFM-DS) at baseline and 1-year follow-up. Within- and between-group comparisons were performed, and procedure-related adverse events were recorded.

Results:

Twenty-three patients (mean age 19.1 ± 6.6 years) were included: 10 underwent GPi-DBS and 13 underwent PVP. Both groups demonstrated significant improvement in BFM-MS and BFM-DS scores at 1 year compared with baseline (p < 0.01). Improvement in BFM-MS scores was significantly greater in the PVP group (p = 0.021), while no significant difference was observed in BFM-DS improvement (p = 0.707). One permanent visual field deficit occurred in the PVP group, and one hardware-related infection occurred in the DBS group.

Conclusion:

Both GPi-DBS and PVP were associated with significant clinical improvement in post-anoxic acquired generalized dystonia. PVP may represent a reasonable alternative in carefully selected patients, particularly in resource-limited settings.

Palabras clave:

Distonía generalizada adquirida Estimulación cerebral profunda Globo pálido interno Palliidotomía Distonía post-anóxica

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