Artikel
Deep brain stimulation is an effective treatment option for segmental dystonia: a prospective series of 15 patients
Die tiefe Hirnstimulation ist eine effektive Behandlungsalternative bei der segmentalen Dystonie: eine prospektive Serie von 15 Patienten
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Autoren
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J.K. Krauss
- Neurochirurgische Klinik, MHH, Hannover
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K. Kekelia
- Neurochirurgische Klinik, MHH, Hannover
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C. Blahak
- Neurologische Klinik, Mannheim
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H.H. Capelle
- Neurochirurgische Klinik, MHH, Hannover
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H. Bäzner
- Neurologische Klinik, Mannheim
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E. Grips
- Neurologische Klinik, Mannheim
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R. Weigel
- Neurochirurgische Klinik, Mannheim
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J.C. Wöhrle
- Neurologische Klinik, Mannheim
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Deep brain stimulation (DBS) has been shown to be a valuable treatment option in patients with otherwise refractory generalized and cervical dystonia. Little is known, however, on its effect for segmental dystonia affecting various body regions. The objective of the present study was to investigate prospectively the long-term effects of DBS in a larger series of patients with segmental dystonia.
Methods: Fifteen patients with refractory segmental dystonia were selected to undergo DBS (7 women, 8 men, age range 30 - 74). Thirteen patients suffered from primary dystonia, and two patients had secondary dystonia. The family history was negative in all instances. The preoperative duration of symptoms ranged between 1 and 35 years. Patients were scheduled either for pallidal DBS or for bifocal pallidal and thalamic DBS (patients with secondary dystonia or marked tremor). The prospective study protocol included assessment of the dystonia by the BFM, UDRS and the GDRS dystonia rating scales.
Results: The stereotactic surgeries were unremarkable and without side effects in 14 instances, while the operation had to be aborted in one patient due to cardiopulmonary problems. All operated patients were available for short-term follow-up (F I, at 4-9 months p.o.) and long-term follow-up (F II, at 12-36 months p.o.). Eight patients underwent pallidal DBS , and six patients had bifocal DBS. On the long-term follow-up 12 patients had pallidal DBS, and 2 had thalamic DBS. There was stable improvement of motor scores both on short- and long-term follow-up (BFM pre 53.8, F II 15.5; UDRS pre 35.4, F II 16.9; GDRS pre 27.5, F II 11.3) which was paralled by improved disability scores (BFM disability pre 6.0, F II 3.9). In three patients, stimulation-induced dysarthria occurred with higher voltages which limited the therapeutic benefit in these patients.
Conclusions: Bilateral DBS is an effective treatment modality in patients with segmental dystonia. Overall, the results are comparable to those obtained in patients with generalized dystonia.
