A randomised double-blind controlled study of Deep Brain Stimulation for dystonia in STN or GPi - A long term follow-up after up to 15 years

Aske Nicolai Hock, Steen Rusborg Jensen, Katrine Wordenskjold Svaerke, Jannick Brennum, Bo Jespersen, Ove Bergdal, Merete Karlsborg, Lena Elisabeth Hjermind, Annemette Lokkegaard*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

25 Citations (Scopus)

Abstract

Aim: This is a long-term open follow-up of a prospective double-blind crossover study, where electrodes were bilaterally implanted in both the Subthalamic nucleus (STN) and internal pallidum (GPi) in patients with isolated dystonia.

Methods: Patients with isolated dystonia were included to undergo surgery with Deep Brain stimulation (DBS) and after randomization, in a double-blind cross-over study, receiving bilateral stimulation of either STN or GPi for 6 months in each target. Preoperative and postoperative assessments with the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and the 36-item Short Form Health Survey (SF-36) were performed. In this long-term follow-up (LFU), these ratings were repeated, and patients were evaluated with cognitive tests.

Results: 21 patients were included in the protocol, 9 patients with generalized dystonia, 12 with a diagnosis of cervical dystonia. The mean duration of disease was 19.3 years, age at time of surgery 50.1 years. Fourteen patients participated in the LFU. At a mean follow-up of 10.2 years (range 4.8-15.4), BFMDRS movement score was improved with a mean of 36% (p < 0.05) compared with baseline. At LFU both a statistically significant improvement of stimulation in STN on BFMDRS movement score (p = 0.029) and Gpi (p = 0.008) was demonstrated, no significant difference was found between the two targets (p = 0.076). SF-36 improved for both targets.

Conclusion: In this study we performed a long-term follow-up in 14 patients with cervical or generalized dystonia, who received stimulation in GPi, STN or both. The mean follow-up time was more than 10 years. Our data support a long-term effect of both STN-DBS and GPi-DBS in dystonia with equal effect and safety for up to 15 years. STN has been proven a viable safe and effective target and may be used as an alternative to GPi in both adult-onset cervical dystonia and generalized dystonia.

Original languageEnglish
JournalParkinsonism & Related Disorders
Volume96
Pages (from-to)74-79
Number of pages6
ISSN1353-8020
DOIs
Publication statusPublished - 2022

Keywords

  • Cervical dystonia
  • Generalized dystonia
  • Deep brain stimulation
  • Internal pallidum
  • Subthalamic nucleus
  • Long term follow-up
  • SUBTHALAMIC NUCLEUS

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