gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

A prospective, randomized assessment of pallidal, thalamic and multifocal deep brain stimulation in a case of stroke-induced hemidystonia

Meeting Abstract

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  • Philipp J. Slotty - Division of Neurosurgery, University of British Columbia, Vancouver, Canada; Abteilung für Stereotaxie und Funktionelle Neurochirurgie, Heinrich-Heine Universität, Düsseldorf, Deutschland
  • Christopher R. Honey - Division of Neurosurgery, University of British Columbia, Vancouver, Canada

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 097

doi: 10.3205/15dgnc495, urn:nbn:de:0183-15dgnc4954

Published: June 2, 2015

© 2015 Slotty et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: In primary and generalized dystonia, the internal pallidum (GPi) is the most common target for deep brain stimulation (DBS) and provides good to excellent results in the majority of patients. Our results in secondary dystonia due to stroke have not been as good and prompted a search for additional DBS targets. The thalamus (Vim/Vop) has been lesioned with success in dystonia and we therefore undertook a study to compare the outcome of GPi DBS versus Vim/Vop DBS versus both.

Method: Three years after suffering a left-sided putaminal stroke due to a heart aneurysm at the age of six, the patient developed a right-sided hemidystonia. At age 22 left sided Vim/Vop and GPi DBS were implanted in a single surgical procedure. Programming was blinded to the patient and examiner and each possible combination of stimulation (GPi only, Vim/Vop only, GPi and Vim/Vop) was tested. After 3 months of stimulation in each setting, the BFMDRS and SF-36 (quality of life) were completed.

Results: Simultaneous GPi and Vim/Vop stimulation was preferred by the patient and resulted in the best functional improvement measured by the BFMDRS and the best improvement in quality of life as measured by the SF-36. Vim/Vop or GPi stimulation alone slightly improved QoL and was felt by the patient to be subjectively better than their baseline but did not result in improvement of dystonia as rated by the BFMDRS.

Conclusions: Simultaneous thalamic and pallidal DBS proved to be the most effective therapy for this patient suffering from secondary hemidystonia due to a putaminal stroke. Multifocal DBS should be considered for post-stroke dystonia and may offer improved outcome in other forms of secondary dystonia with limited response to GPi DBS.