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Deep brain stimulation for treatment of dystonia secondary to stroke or trauma
  1. Elizabeth J Slow1,
  2. Clement Hamani2,
  3. Andres M Lozano2,
  4. Yu Yan Poon1,
  5. Elena Moro1,3
  1. 1Division of Neurology, Movement Disorders Center, TWH, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Neurosurgery, TWH, University of Toronto, Toronto, Ontario, Canada
  3. 3Movement Disorders Unit, Department of Psychiatry and Neurology, University Hospital Center (CHU) of Grenoble, Joseph Fourier University, Grenoble, France
  1. Correspondance to
    Professor Elena Moro, Unité des Troubles du mouvement, Pole de Psychiatrie et de Neurologie, Centre Hospitalier Universitaire de Grenoble BP 217, 38043 Grenoble CEDEX 09, France; emoro{at}chu-grenoble.fr

http://dx.doi.org/10.1136/jnnp-2014-308943

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    Introduction

    Globus pallidus pars interna (GPi) deep brain stimulation (DBS) is efficacious for reduction of medically refractory, primary, generalised dystonia and subtypes of acquired dystonia,1 but there is little evidence supporting the efficacy of DBS in dystonia acquired after stroke or traumatic brain injury (TBI).

    Dystonia has been reported in up to 4% of patients with post-stroke2 and up to 20% of patients after severe TBI.3 Patients who develop dystonia after stroke or TBI are typically adolescents/young adults, in whom dystonia manifests in days to years after the initial event. Brain MRI abnormalities are often present, typically in the basal ganglia. The most frequent type of dystonia observed in this population is hemidystonia, which is usually refractory to medical management.3 Since young adults are predominantly afflicted and the dystonia is often medically refractory, this population experiences significant disability for the majority of their lifetime.

    In order to determine if DBS can be beneficial to this population, we have analysed patients’ outcomes from the Toronto Western Hospital (TWH) DBS database in a retrospective, observational study.

    Methods

    All patients who received DBS for dystonia acquired after stroke/TBI were identified through a search of the TWH DBS dystonia database (1995–2012) and were included in the study. Dystonia was diagnosed by a movement disorder neurologist. The study was reviewed and approved by the Research Ethics Board of the University Health Network. Details of DBS surgery have been published previously.4 Post-DBS MRI were performed to verify correct …

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    Footnotes

    • Contributors EJS performed the prospective chart review, video rating, statistics, and drafted and revised the paper. CH and AML performed the surgeries, provided data and revised the manuscript. YYP was involved in data acquisition and management of the project. EM designed the work, managed the patients, provided the data and the videos, helped with data analysis and interpretation, and critically revised the manuscript. EJS and EM are guarantors of the paper.

    • Competing interests CH is a consultant for St Jude Medical. AML is a consultant for Medtronic, Boston Scientific and St Jude Medical. EM is a consultant for Medtronic. She has received honoraria for consulting services and lecturing from Medtronic, Boston Medical, St. Jude, and USB.

    • Ethics approval Research Ethics Board of the University Health Network, Toronto, Ontario, Canada.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement EJS and EM had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.