Journal Mobile Options
Table of Contents
Vol. 88, No. 4, 2010
Issue release date: July 2010
Stereotact Funct Neurosurg 2010;88:234–238

Comparison of Treatment Results between Selective Peripheral Denervation and Deep Brain Stimulation in Patients with Cervical Dystonia

Huh R. · Han I.B. · Chung M. · Chung S.
Department of Neurosurgery, CHA University, Bundang CHA Hospital, Sungnam, Korea

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background/Aims: Cervical dystonia (CD) is the most common form of focal dystonia. The treatment options for CD include medical therapy and surgery. The 3 basic types of CD are tonic, phasic and tremulous. Selective peripheral denervation (SPD) and globus pallidus internus (GPi) deep brain stimulation (DBS) have been developed as therapeutic options for the treatment of CD. Methods: Between 1997 and 2009, 24 patients with CD underwent operations: either SPD (n = 16) or DBS (n = 8). The mean follow-up period was 29.5 months (range = 2–59). The mean age at onset of symptoms was 46.6 years (range = 27–65). The patients were evaluated with the subjective scores and the Toronto Western Spasmodic Torticollis Scale scores. Results: All patients showed gradual improvement after SPD and DBS. No statistically significant differences were seen between the SPD group and the DBS group. However, there was a trend toward greater pain reduction in the DBS group (p = 0.094). Conclusion: Both the SPD group and the DBS group showed successful improvement in their Toronto Western Spasmodic Torticollis Scale scores as well as subjective scores. The GPi DBS group showed a remarkable improvement on the pain scale and there was a trend toward greater pain reduction in the DBS group.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Dauer WT, Burke RE, Greene P, Fahn S: Current concepts on the clinical features, aetiology and management of idiopathic cervical dystonia. Brain 1998;121:547–560.
  2. Adler CH, Kumar R: Pharmacological and surgical options for the treatment of cervical dystonia. Neurology 2000;55:S9–S14.
  3. Crowner BE: Cervical dystonia: disease profile and clinical management. Phys Ther 2007;87:1511–1526.
  4. Deuschl G, Heinen F, Kleedorfer B, Wagner M, Lucking CH, Poewe W: Clinical and polymyographic investigation of spasmodic torticollis. J Neurol 1992;239:9–15.
  5. Eltahawy HA, Saint-Cyr J, Poon YY, Moro E, Lang AE, Lozano AM: Pallidal deep brain stimulation in cervical dystonia: clinical outcome in four cases. Can J Neurol Sci 2004;31:328–332.
  6. Loher TJ, Pohle T, Krauss JK: Functional stereotactic surgery for treatment of cervical dystonia: review of the experience from the lesional era. Stereotact Funct Neurosurg 2004;82:1–13.
  7. Munchau A, Palmer JD, Dressler D, O’Sullivan JD, Tsang KL, Jahanshahi M, et al: Prospective study of selective peripheral denervation for botulinum-toxin-resistant patients with cervical dystonia. Brain 2001;124:769–783.
  8. Sheean G: Cervical dystonia: unresolved issues and future challenges. Neurol Clin 2008;26(suppl 1):66–76.
  9. Singer C, Velickovic M: Cervical dystonia: etiology and pathophysiology. Neurol Clin 2008;26(suppl 1):9–22.
  10. Swope D, Barbano R: Treatment recommendations and practical applications of botulinum toxin treatment of cervical dystonia. Neurol Clin 2008;26(suppl 1):54–65.
  11. Bertrand CM: Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observations in 260 cases. Surg Neurol 1993;40:96–103.
  12. Ostrem JL, Starr PA: Treatment of dystonia with deep brain stimulation. Neurotherapeutics 2008;5:320–330.
  13. Bittar RG, Yianni J, Wang S, Liu X, Nandi D, Joint C, et al: Deep brain stimulation for generalised dystonia and spasmodic torticollis. J Clin Neurosci 2005;12:12–16.
  14. Loher TJ, Capelle HH, Kaelin-Lang A, Weber S, Weigel R, Burgunder JM, et al: Deep brain stimulation for dystonia: outcome at long-term follow-up. J Neurol 2008;255:881–884.
  15. Vitek JL, Chockan V, Zhang JY, Kaneoke Y, Evatt M, Delong MR, et al: Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol 1999;46:22–35.
  16. Krauss JK, Yianni J, Loher TJ, Aziz TZ: Deep brain stimulation for dystonia. J Clin Neurophysiol 2004;21:18–30.
  17. Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Lagrance C, Yelnik J, et al: Bilateral pallidal deep brain stimulation in primary generalized dystonia: a prospective three-year follow-up study. Lancet Neurol 2007;6:223–229.
  18. Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Cornu P, Lagrance C, et al: Bilateral deep-brain stimulation of globus pallidus in primary generalized dystonia. N Engl J Med 2007;6:223–229.
  19. Ford B, Louis ED, Greene P, Fahn S: Outcome of selective ramisectomy for botulinum toxin resistant torticollis. J Neurol Neurosurg Psychiatry 1998;65:472–478.
  20. Braun V, Richter HP: Selective peripheral denervation for the treatment of spasmodic torticollis. Neurosurgery 1994;35:58–62; discussion 62–63.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50