Deep brain stimulation in dystonia: factors contributing to variability in outcome in short and long term follow-up.

Abstract

PURPOSE OF REVIEW:

Deep brain stimulation (DBS) is currently the most effective treatment for medically refractory dystonia with globus pallidus internus (GPi) usually the preferred target. Despite the overall success of DBS in dystonia, there remains variability in treatment outcome in both short and long-term follow-up, due to various factors. Factors contributing to variability in outcome comprise 'Dystonia Related' including dystonia classification, semiology, duration, body distribution, orthopaedic deformity, aetiology and genetic cause. The majority of these factors are identifiable from clinical assessment, brain MRI and genetic testing, and therefore merit careful preoperative consideration. 'DBS related' factors include brain target, accuracy of lead placement, stimulation parameters, time allowed for response, neurostimulation technology employed and DBS induced side-effects. In this review, factors contributing to variability in short and long-term dystonia DBS outcome are reviewed and discussed.

RECENT FINDINGS:

The recognition of differential DBS benefit in monogenic dystonia, increasing experience with subthalamic nucleus (STN) DBS and in DBS for Meige syndrome, elucidation of DBS side effects and novel neurophysiological and imaging techniques to assist in predicting clinical outcome.

SUMMARY:

Improved understanding of factors contributing to variability of DBS outcome in dystonia may assist in patient selection and predicting surgical outcomes.

• Authors: Stephen Tisch
• Journal: Current opinion in neurology (Curr Opin Neurol) Vol. 35 Issue 4 Pg. 510-517 (08 01 2022) ISSN: 1473-6551 [Electronic] England
• PMID: 35787538 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Topics

• Deep Brain Stimulation (methods)
• Dystonia (therapy)
• Dystonic Disorders (therapy)
• Follow-Up Studies
• Globus Pallidus (physiology, surgery)
• Humans
• Subthalamic Nucleus
• Treatment Outcome