Pallidal high-frequency deep brain stimulation for camptocormia: an experience of three cases

Summary

Introduction. The term “camptocormia” describes a forward-flexed posture. It is a condition characterized by severe frontal flexion of the trunk. Recently, camptocormia has been regarded as a form of abdominal segmental dystonia. Deep brain stimulation (DBS) is a promising therapeutic approach to various types of movement disorders. The authors report the neurological effects of DBS to the bilateral globus pallidum (GPi) in three cases of disabling camptocormia.

Methods. Of the 36 patients with dystonia, three had symptoms similar to that of camptocormia, and all of these patients underwent GPi-DBS. The site of DBS electrode placement was verified by magnetic resonance imaging (MRI). The Burke Fahn and Marsden dystonia rating scale (BFMDRS) was employed to evaluate the severity of dystonic symptoms preoperatively and postoperatively.

Results. Significant functional improvement following GPi-DBS was noted in the majority of dystonia cases. At a follow-up observation after more than six months, the overall improvement rate was 71.2 ± 27.0%, in all dystonia cases who underwent the GPi-DBS. In contrast, the improvement rate of the three camptocormia cases was 92.2 ± 5.3%. It was confirmed that the improvement rate for camptocormia was much higher than for other types of dystonia.

Conclusion. According to our experience, a patient with a forward-bent dystonic posture indicative of camptocormia is a good candidate for GPi-DBS. The findings of this study add further support to GPi-DBS as an effective treatment for dystonia, and provide the information on predictors of a good outcome.