BACKGROUND: Globus Pallidus Interna (GPi) deep brain stimulation (DBS) is an effective treatment for DYT1-associated dystonia, but long-term results are lacking.
OBJECTIVE: To evaluate the long-term effects of GPi DBS in patients with DYT1 dystonia.
METHODS: A retrospective chart review (cohort study) of 47 consecutive DYT1+ patients treated by a single surgical team over a 10-year period and followed for up to 96 months (mean, 46 months) was performed. Symptom severity was quantified with the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor (M) and disability (D) sub-scores.
RESULTS: As measured with the BFMDRS (M), symptom severity was reduced to less than 20% of baseline after 2 years of DBS therapy (P = .001). The disability scores were reduced to <30% of baseline (P = .001). Symptomatic improvement was durable throughout available follow-up. Sixty-one percent of patients had discontinued all dystonia-related medications at their last follow-up. Ninety-one percent had discontinued at least 1 class of medication. Infections requiring removal and later reimplantation of hardware occurred in 4 of 47 patients (8.5%). Hardware malfunction including lead fractures occurred in 4 of 47 cases (8.5%). Lead revision to address poor clinical response was performed in 2 of 92 implanted leads (2.2%).
CONCLUSION: GPi DBS is an effective therapy for DYT1-associated torsion dystonia. Statistically significant efficacy is maintained for up to 7 years. Neurologic complications are rare, but long-term hardware-related complications can be significant.
ABBREVIATIONS: BFMDRS, Burke-Fahn-Marsden Dystonia Rating Scale
DBS, deep brain stimulation
GPi, globus pallidus interna
MCP, mid-commissural point
PGD, primary generalized dystonia
*Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York;
‡New York College of Osteopathic Medicine, Old Westbury, New York;
§Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California;
¶Department of Neurology, Beth Israel Medical Center, New York, New York;
‖Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Correspondence: Ron L. Alterman, MD, Department of Surgery, Beth Israel Deaconess Medical Center, West Campus, Lowry Office Building, Suite 3B, 110 Francis Street, Boston, MA 02215. E-mail: firstname.lastname@example.org
Received October 28, 2012
Accepted March 07, 2013