低酸素脳症後汎発性ジストニアの管理における両側淡蒼球深部脳刺激術と両側淡蒼球切開術の比較

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.

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.

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.

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.

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.