Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia.

By M. Vidailhet, L. Vercueil, J. Houeto, P. Krystkowiak, A. Benabid, P. Cornu, C. Lagrange, S. Tezenas du Montcel, Didier Dormont, S. Grand and 7 more. New England Journal of Medicine, 2005

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BACKGROUND Severe forms of dystonia respond poorly to medical treatment. Deep-brain stimulation is a reversible neurosurgical procedure that has been used for the treatment of dystonia, but assessment of its efficacy has been limited to open studies. METHODS We performed a prospective, controlled, multicenter study assessing the efficacy and safety of bilateral pallidal stimulation in 22 patients with primary generalized dystonia. The severity of dystonia was evaluated before surgery and 3, 6, and 12 months postoperatively during neurostimulation, with the use of the movement and disability subscores of the Burke-Fahn-Marsden Dystonia Scale (range, 0 to 120 and 0 to 30, respectively, with higher scores indicating greater impairment). Movement scores were assessed by a review of videotaped sessions performed by an observer who was unaware of treatment status. At three months, patients underwent a double-blind evaluation in the presence and absence of neurostimulation. We also assessed the patients' quality of life, cognition, and mood at baseline and 12 months. RESULTS The dystonia movement score improved from a mean (+/-SD) of 46.3+/-21.3 before surgery to 21.0+/-14.1 at 12 months (P<0.001). The disability score improved from 11.6+/-5.5 before surgery to 6.5+/-4.9 at 12 months (P<0.001). General health and physical functioning were significantly improved at month 12; there were no significant changes in measures of mood and cognition. At the three-month evaluation, dystonia movement scores were significantly better with neurostimulation than without neurostimulation (24.6+/-17.7 vs. 34.6+/-12.3, P<0.001). There were five adverse events (in three patients); all resolved without permanent sequelae. CONCLUSIONS These findings support the efficacy and safety of the use of bilateral stimulation of the internal globus pallidus in selected patients with primary generalized dystonia.

Subfields: Neurology

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Citations in the corpus

Lead-DBS: A toolbox for deep brain stimulation electrode localizations and visualizations (2015, background): “Although other factors influence the clinical outcome of DBS (Lumsden et al., 2013; Vidailhet et al., 2005), contact mislocation is considered to be the most common cause of a poor clinical response (Ellis et al., 2008;Marks et al., 2009).”
Deep brain stimulation for treatment-resistant depression. (2005, neutral): “…DBS discontinuation has been observed in other disorders targeting different brain circuits, including epilepsy, essential tremor, dystonia, and Parkinson’s disease (Hodaie et al. 2002, Kumar et al. 2003; Deep-Brain Stimulation for Parkinson’s Disease Study Group, 2001; Vidailhet et al., 2005).”
Deep brain stimulation. (2006, neutral): “In a recent controlled trial of pallidal DBS in 22 patients with primary generalized dystonia, there was a 30%–50% improvement in symptoms (Vidailhet et al. 2005).”
Patient-specific analysis of the volume of tissue activated during deep brain stimulation (2007, background): “Deep brain stimulation (DBS) is an established therapy for the treatment of Parkinson's disease (PD) (Obeso et al., 2001), essential tremor (Benabid et al., 1996), and dystonia (Vidailhet et al., 2005).”