Short- and long-term outcome of chronic pallidal neurostimulation in monogenic isolated dystonia

Norbert Brüggemann*, Andrea Kühn, Susanne A. Schneider, Christoph Kamm, Alexander Wolters, Patricia Krause, Elena Moro, Frank Steigerwald, Matthias Wittstock, Volker Tronnier, Andres M. Lozano, Clement Hamani, Yu Yan Poon, Simone Zittel, Tobias Wächter, Günther Deuschl, Rejko Krüger, Andreas Kupsch, Alexander Münchau, Katja LohmannJens Volkmann, Christine Klein

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

97 Citations (Scopus)

Abstract

Objectives: Deep brain stimulation of the internal pallidum (GPi-DBS) is an established therapeutic option in treatment-refractory dystonia, and the identification of factors predicting surgical outcome is needed to optimize patient selection. Methods: In this retrospective multicenter study, GPi-DBS outcome of 8 patients with DYT6, 9 with DYT1, and 38 with isolated dystonia without known monogenic cause (non-DYT) was assessed at early (1-16 months) and late (22-92 months) follow-up using Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores. Results: At early follow-up, mean reduction of dystonia severity was greater in patients with DYT1 (BFMDRS score: -60%) and non-DYT dystonia (-52%) than in patients with DYT6 dystonia (-32%; p = 0.046). Accordingly, the rate of responders was considerably lower in the latter group (57% vs >90%; p = 0.017). At late follow-up, however, GPi-DBS resulted in comparable improvement in all 3 groups (DYT6, -42%; DYT1, -44; non-DYT, -61%). Additional DBS of the same or another brain target was performed in 3 of 8 patients with DYT6 dystonia with varying results. Regardless of the genotype, patients with a shorter duration from onset of dystonia to surgery had better control of dystonia postoperatively. Conclusions: Long-term GPi-DBS is effective in patients with DYT6, DYT1, and non-DYT dystonia. However, the effect of DBS appears to be less predictable in patients with DYT6, suggesting that pre-DBS genetic testing and counseling for known dystonia gene mutations may be indicated. GPi-DBS should probably be considered earlier in the disease course. Classification of evidence: This study provides Class IV evidence that long-termGPi-DBS improves dystonia in patients with DYT1, DYT6, and non-DYT dystonia.

Original languageEnglish
Pages (from-to)895-903
Number of pages9
JournalNeurology
Volume84
Issue number9
DOIs
Publication statusPublished - 3 Mar 2015
Externally publishedYes

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