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J Neurol Neurosurg Psychiatry 84:1029-1042 doi:10.1136/jnnp-2011-301714
  • Movement disorders
  • Review

Deep brain stimulation for dystonia

Editor's Choice
  1. Emmanuel Roze1,2,3
  1. 1AP-HP, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
  2. 2Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), CNRS UMR 7225, UPMC Université Paris 6/Inserm UMR_S 975, Paris, France
  3. 3Pierre et Marie Curie-Paris-6 University, Paris, France
  1. Correspondence to Professor Marie Vidailhet, Department of Neurology and UMRS 975, Salpêtrière Hospital, Boulevard de l'Hôpital, Paris 75013, France;marie.vidailhet{at}psl.aphp.fr
  • Received 11 June 2012
  • Accepted 15 October 2012
  • Published Online First 15 November 2012

Abstract

The few controlled studies that have been carried out have shown that bilateral internal globus pallidum stimulation is a safe and long-term effective treatment for hyperkinetic disorders. However, most recent published data on deep brain stimulation (DBS) for dystonia, applied to different targets and patients, are still mainly from uncontrolled case reports (especially for secondary dystonia). This precludes clear determination of the efficacy of this procedure and the choice of the ‘good’ target for the ‘good’ patient. We performed a literature analysis on DBS for dystonia according to the expected outcome. We separated those with good evidence of favourable outcome from those with less predictable outcome. In the former group, we review the main results for primary dystonia (generalised/focal) and highlight recent data on myoclonus-dystonia and tardive dystonia (as they share, with primary dystonia, a marked beneficial effect from pallidal stimulation with good risk/benefit ratio). In the latter group, poor or variable results have been obtained for secondary dystonia (with a focus on heredodegenerative and metabolic disorders). From this overview, the main results and limits for each subgroup of patients that may help in the selection of dystonic patients who will benefit from DBS are discussed.

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