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Long-Term Benefit Sustained after Bilateral Pallidal Deep Brain Stimulation in Patients with Refractory Tardive Dystonia

Chang E.F.a · Schrock L.E.b · Starr P.A.a, c · Ostrem J.L.b, c
Departments of aNeurological Surgery and bNeurology, University of California, and cDepartment of Veterans Affairs Parkinson’s Disease Research, Education and Clinical Center, San Francisco, Calif., USA Stereotact Funct Neurosurg 2010;88:304–310 (DOI:10.1159/000316763)

Abstract

Background/Aims: Tardive dystonia (TD) can be a highly disabling, permanent condition related to the use of dopamine-receptor-blocking medications. Our aim was to evaluate the long-term effect of bilateral pallidal deep brain stimulation (DBS) for TD. Methods: Five consecutive patients with disabling TD who underwent stereotactic placement of bilateral globus pallidus internus DBS leads were included. All patients had a history of mood disorder or schizophrenia previously treated with neuroleptic medication, with a mean duration of motor symptoms of 10.2 years. Dystonia severity was measured using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) movement score by a blinded neurologist reviewing pre- and postoperative videotaped examinations. Results: The mean baseline movement BFMDRS score was 49.7 (range 20–88). Overall, we observed a mean reduction of 62% in the BFMDRS movement score within the first year after surgery. Persistent improvement in dystonia (71%) was seen at the last follow-up ranging from 2 to 8 years after surgery. Conclusion: Our experience suggests that pallidal DBS can be an effective therapy with long-term benefits for patients with TD.

 

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