BACKGROUND: Pallidal deep brain stimulation (DBS) is the best therapeutic option for patients with disabling primary generalized dystonia (PGD) that is refractory to medications. However, little is known about its long-term effects. OBJECTIVE: To describe long-term clinical outcomes in patients with PGD who underwent pallidal DBS. DESIGN: Case series. SETTING: University hospital. PATIENTS: Thirty consecutive patients with at least 2 years' follow-up after pallidal DBS for intractable PGD. INTERVENTIONS: Pallidal DBS and annual follow-up examinations up to 8 years after DBS implantation. MAIN OUTCOME MEASURES: Clinical outcome as measured by changes in the Burke-Fahn-Marsden dystonia scale, incidence and prevalence of adverse events, total electrical energy delivered, and implantable pulse generator longevity. RESULTS: Twenty-three patients were followed for 3 years, 13 for 4 years, 9 for 5 years, 5 for 6 years, 5 for 7 years, and 1 for 8 years after DBS. Overall improvement at 1 year was maintained in all at successive yearly examinations. There were no intraoperative complications; hardware-related adverse events were infrequent. Rare stimulation-related adverse events primarily affected speech. Implantable pulse generators were replaced every 24 months on average in patients who received initial stimulation at 130-Hz frequency. No battery was replaced, for up to 48 months, in 20 patients initially stimulated using 60 Hz. Clinical outcome did not depend on high energies of stimulation. CONCLUSIONS: Pallidal DBS is a safe and effective treatment for PGD, with improvement sustained for up to 8 years in 1 patient. Low energies of stimulation, although they did not affect clinical outcome, were associated with longer battery life.
BACKGROUND: Pallidal deep brain stimulation (DBS) is the best therapeutic option for patients with disabling primary generalized dystonia (PGD) that is refractory to medications. However, little is known about its long-term effects. OBJECTIVE: To describe long-term clinical outcomes in patients with PGD who underwent pallidal DBS. DESIGN: Case series. SETTING: University hospital. PATIENTS: Thirty consecutive patients with at least 2 years' follow-up after pallidal DBS for intractable PGD. INTERVENTIONS: Pallidal DBS and annual follow-up examinations up to 8 years after DBS implantation. MAIN OUTCOME MEASURES: Clinical outcome as measured by changes in the Burke-Fahn-Marsden dystonia scale, incidence and prevalence of adverse events, total electrical energy delivered, and implantable pulse generator longevity. RESULTS: Twenty-three patients were followed for 3 years, 13 for 4 years, 9 for 5 years, 5 for 6 years, 5 for 7 years, and 1 for 8 years after DBS. Overall improvement at 1 year was maintained in all at successive yearly examinations. There were no intraoperative complications; hardware-related adverse events were infrequent. Rare stimulation-related adverse events primarily affected speech. Implantable pulse generators were replaced every 24 months on average in patients who received initial stimulation at 130-Hz frequency. No battery was replaced, for up to 48 months, in 20 patients initially stimulated using 60 Hz. Clinical outcome did not depend on high energies of stimulation. CONCLUSIONS: Pallidal DBS is a safe and effective treatment for PGD, with improvement sustained for up to 8 years in 1 patient. Low energies of stimulation, although they did not affect clinical outcome, were associated with longer battery life.
Authors: P Krause; K Lauritsch; A Lipp; A Horn; B Weschke; A Kupsch; K L Kiening; G-H Schneider; A A Kühn Journal: J Neurol Date: 2016-08-27 Impact factor: 4.849