Long-term efficacy with deep brain stimulation of the globus pallidus internus in cervical dystonia: a retrospective monocentric study

Clemens Jacksch; Kirsten E Zeuner; Ann-Kristin Helmers; Karsten Witt; Günther Deuschl; Steffen Paschen

doi:10.1186/s42466-022-00214-8

Long-term efficacy with deep brain stimulation of the globus pallidus internus in cervical dystonia: a retrospective monocentric study

Neurol Res Pract. 2022 Oct 3;4(1):48. doi: 10.1186/s42466-022-00214-8.

Authors

Clemens Jacksch¹, Kirsten E Zeuner², Ann-Kristin Helmers³, Karsten Witt⁴, Günther Deuschl², Steffen Paschen²

Affiliations

¹ Department of Neurology, Christian Albrechts-University of Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany. Clemens.Jacksch@uksh.de.
² Department of Neurology, Christian Albrechts-University of Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany.
³ Department of Neurosurgery, Christian Albrechts-University of Kiel, Kiel, Germany.
⁴ Department of Neurology and Research Center Neurosensory Science, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany.

Abstract

Background: Cervical dystonia (CD) is characterized by involuntary contractions of the cervical muscles. Data on long-term effectiveness of deep brain stimulation (DBS) are rare. The aim of this study was to evaluate the longitudinal ten years treatment efficacy of DBS in the globus pallidus internus (GPI).

Methods: A retrospective single-center data analysis was performed on patients with idiopathic CD, who were treated with GPI DBS for at least 10 years. TWSTR severity score and individual sub-items were compared between pre and post DBS surgery (n = 15) over time.

Results: There was a significant and persistent positive effect regarding the severity of TWSTRS between the conditions immediately before and 1, 5, and 10 years after establishment of GPI DBS (mean difference: 6.6-7 ± 1.6). Patients with increasing CD complexity showed a poorer response to established treatment forms, such as injection of botulinum toxin and were thus DBS candidates. Especially a predominant torticollis was significantly improved by DBS.

Conclusion: GPI DBS is an effective procedure especially in severely affected patients with a positive 10-year outcome. It should be considered in more complex CD-forms or predominant torticollis.

Keywords: Deep brain stimulation; Idiopathic cervical dystonia; Long-term effectiveness.