gms | German Medical Science

Objective: In patients with severe segmental dystonia both pallidotomy and thalamotomy/subthalamotomy was used in the past. Little is known about the outcome of pallidal DBS in patients in whom pallidotomy or thalmotomy/subthalamotomy and peripheral denervation loses effect.

Method: We report on two patients who had radiofrequency lesioning and underwent subsequent DBS. The first patient with segmental dystonia had repeated bilateral pallidotomy and peripheral denervation procedures. After loss of efficacy he underwent pallidal DBS. The second patient with cervical dystonia had unilateral thalamotomy/subthalamotomy and peripheral denervation procedures before he underwent pallidal DBS.

Results: Follow-up time was 40-52 months. In the first patient marked improvement was seen after pallidal stimulation reflected in the amelioration of the BfM motor score from 53 to 9.5. In the second patient the BfM motor score improved from 6 to 4 and the TWISTRS torticollis severity score improved from 23 to 14 during long-term follow-up.

Conclusions: Patients who had prior pallidotomy or thalamotomy/subthalamotomy and peripheral denervation procedures for segmental and cervical dystonia can experience further improvement from subsequent pallidal DBS. Patients with previous pallidotomy may respond better than with previous thalamotomy. These patients should therefore not be excluded from subsequent DBS surgery.