Alain Kaelin-Lang1, Hana You2, Jean-Marc Burgunder3, Tarja Lönnfors-Weitze4, Thomas J Loher5, Ethan Taub6, Ioannis U Isaias7, Joachim K Krauss8, W M Michael Schüpbach9. 1. Department of Neurology, Inselspital, Berne University Hospital, Berne, Switzerland; Neurocenter of Southern Switzerland, Lugano, Switzerland; Faculty of Biomedical Sciences, Universita Della Svizzera Italiana, Lugano, Switzerland. 2. Department of Neurology, Inselspital, Berne University Hospital, Berne, Switzerland. 3. Department of Neurology, Inselspital, Berne University Hospital, Berne, Switzerland; Neurocenter Siloah, Gümligen-Muri, Switzerland. 4. University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Berne University Hospital, Berne, Switzerland. 5. Department of Neurology, Inselspital, Berne University Hospital, Berne, Switzerland; Neurocenter Berne, Berne, Switzerland. 6. Functional Neurosurgery Unit, Department of Neurosurgery, Kantonspital, University Hospital, Basel, Switzerland. 7. Department of Neurology, University Hospital, Würzburg, Germany. 8. Department of Neurosurgery, Medical School Hannover, Hannover, Germany; Center of Systems Neuroscience, Hannover, Germany. Electronic address: krauss.joachim@mh-hannover.de. 9. Department of Neurology, Inselspital, Berne University Hospital, Berne, Switzerland; Institute of Neurology, Konolfingen, Switzerland.
Abstract
INTRODUCTION: Deep brain stimulation (DBS) is an effective treatment in medically resistant cervical dystonia (CD) with a documented therapeutic effect. Long term outcome beyond a decade, however, has not been studied systematically. METHODS: To investigate the impact of pallidal DBS beyond 10 years in CD we followed a series of five consecutive patients with severe medication-resistant CD. Severity of head and neck deviation, disability, and pain related to dystonia were assessed by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) in the frame of a prospective study. The primary endpoint of this study was a change in the TWSTRS total score. Secondary endpoints were changes in the subscores of the TWSTRS. RESULTS: The mean follow-up time was 11.5 years (range 10-12.8). Comparing baseline and the last follow-up, CD improved by 53% on the total TWSTRS score, by 54.1% on the severity score, and by 70.1% on the disability score, while pain did not improve significantly. Improvement was stable over time. Patients with a tonic pattern of CD responded less to DBS than patients with a phasic pattern. DBS had no significant effect on mood and cognition. Two patients underwent electrode revisions. One patient had an infection of the proximal cable two years after surgery. CONCLUSIONS: Chronic bilateral pallidal stimulation improves severity of dystonia and disability over more than a decade in treatment resistant CD. Results may vary among individual patients.
INTRODUCTION: Deep brain stimulation (DBS) is an effective treatment in medically resistant cervical dystonia (CD) with a documented therapeutic effect. Long term outcome beyond a decade, however, has not been studied systematically. METHODS: To investigate the impact of pallidal DBS beyond 10 years in CD we followed a series of five consecutive patients with severe medication-resistant CD. Severity of head and neck deviation, disability, and pain related to dystonia were assessed by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) in the frame of a prospective study. The primary endpoint of this study was a change in the TWSTRS total score. Secondary endpoints were changes in the subscores of the TWSTRS. RESULTS: The mean follow-up time was 11.5 years (range 10-12.8). Comparing baseline and the last follow-up, CD improved by 53% on the total TWSTRS score, by 54.1% on the severity score, and by 70.1% on the disability score, while pain did not improve significantly. Improvement was stable over time. Patients with a tonic pattern of CD responded less to DBS than patients with a phasic pattern. DBS had no significant effect on mood and cognition. Two patients underwent electrode revisions. One patient had an infection of the proximal cable two years after surgery. CONCLUSIONS: Chronic bilateral pallidal stimulation improves severity of dystonia and disability over more than a decade in treatment resistant CD. Results may vary among individual patients.
Authors: Alfonso E Martinez-Nunez; Christos Sidiropoulos; Julia Wall; Jason Schwalb; Ellen Air; Peter LeWitt; Bisena Bulica; Patricia Kaminski; Neepa Patel Journal: Front Neurol Date: 2022-08-05 Impact factor: 4.086