Journal Mobile Options
Table of Contents
Vol. 90, No. 1, 2012
Issue release date: February 2012
Stereotact Funct Neurosurg 2012;90:30–36

Effects of Relative Low-Frequency Bilateral Globus Pallidus Internus Stimulation for Treatment of Cervical Dystonia

Kim J.P. · Chang W.S. · Park Y.S. · Chang J.W.
Department of Neurosurgery, Severance Hospital, Brain Korea 21 Project for Medical Science, Brain Research Institute, Yonsei University College of Medicine, Seoul, 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


Objective: To assess the effect of relative lower amplitude and frequency for globus pallidus internus (GPi) deep brain stimulation (DBS) of cervical dystonia (CD). Materials and Methods: Between February 2005 and October 2008, 14 patients diagnosed with CD underwent bilateral GPi DBS and all the patients received low-frequency stimulation and were followed for more than 2 years. We activated the implantable pulse generator 3–4 days postoperatively and initial amplitude, pulse width, and frequency were set at 1.5 V, 120 µs, and 70 Hz. The Toronto Western Spasmodic Torticolis Rating Scale (TWSTRS) was applied preoperatively and at 1, 6, 12 and 24 months postoperatively. Results: The overall TWSTRS scores improved 71.2% 2 years postoperatively (p = 0.001). The mean improvement was 78.4% in severity subscores, 68.4% in disability, and 66.8% in pain scores for the 2-year follow-up period. The TWSTRS scores were significantly reduced (p < 0.05), suggesting that the most significant improvement of the TWSTRS scores occurred within 1 month. The final amplitude was 2.9/2.7 V with the pulse width of 147.9/147.9 µs and the frequency of 101.1/100 Hz. Conclusion: According to our results, the initial settings of low amplitude and especially relatively low frequency are safe and effective for treatment of CD.

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. Fahn S: Concept and classification of dystonia. Adv Neurol 1988;50:1–8.
  2. Krauss JK: Deep brain stimulation for cervical dystonia. J Neurol Neurosurg Psychiatry 2003;74:1598.
  3. Huh R, Han IB, Chung M, Chung S: Comparison of treatment results between selective peripheral denervation and deep brain stimulation in patients with cervical dystonia. Stereotact Funct Neurosurg 2010;88:234–238.
  4. 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.
  5. Hung SW, Hamani C, Lozano AM, Poon YY, Piboolnurak P, Miyasaki JM, Lang AE, Dostrovsky JO, Hutchison WD, Moro E: Long-term outcome of bilateral pallidal deep brain stimulation for primary cervical dystonia. Neurology 2007;68:457–459.
  6. Kiss ZH, Doig-Beyaert K, Eliasziw M, Tsui J, Haffenden A, Suchowersky O: The Canadian multicentre study of deep brain stimulation for cervical dystonia. Brain 2007;130:2879–2886.
  7. Krauss JK, Pohle T, Weber S, Ozdoba C, Burgunder JM: Bilateral stimulation of globus pallidus internus for treatment of cervical dystonia. Lancet 1999;354:837–838.
  8. Cacciola F, Farah JO, Eldridge PR, Byrne P, Varma TK: Bilateral deep brain stimulation for cervical dystonia: long-term outcome in a series of 10 patients. Neurosurgery 2010;67:957–963.
  9. Moro E, Piboolnurak P, Arenovich T, Hung SW, Poon YY, Lozano AM: Pallidal stimulation in cervical dystonia: clinical implications of acute changes in stimulation parameters. Eur J Neurol 2009;16:506–512.
  10. Cif L, El Fertit H, Vayssiere N, Hemm S, Hardouin E, Gannau A, Tuffery S, Coubes P: Treatment of dystonic syndromes by chronic electrical stimulation of the internal globus pallidus. J Neurosurg Sci 2003;47:52–55.
  11. Yianni J, Bain P, Giladi N, Auca M, Gregory R, Joint C, Nandi D, Stein J, Scott R, Aziz T: Globus pallidus internus deep brain stimulation for dystonic conditions: a prospective audit. Mov Disord 2003;18:436–442.
  12. Coubes P, Cif L, El Fertit H, Hemm S, Vayssiere N, Serrat S, Picot MC, Tuffery S, Claustres M, Echenne B, Frerebeau P: Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results. J Neurosurg 2004;101:189–194.
  13. Vidailhet M, Yelnik J, Lagrange C, Fraix V, Grabli D, Thobois S, Burbaud P, Welter ML, Xie-Brustolin J, Braga MC, Ardouin C, Czernecki V, Klinger H, Chabardes S, Seigneuret E, Mertens P, Cuny E, Navarro S, Cornu P, Benabid AL, Le Bas JF, Dormont D, Hermier M, Dujardin K, Blond S, Krystkowiak P, Destee A, Bardinet E, Agid Y, Krack P, Broussolle E, Pollak P: Bilateral pallidal deep brain stimulation for the treatment of patients with dystonia-choreoathetosis cerebral palsy: a prospective pilot study. Lancet Neurol 2009;8:709–717.
  14. Starr PA, Turner RS, Rau G, Lindsey N, Heath S, Volz M, Ostrem JL, Marks WJ Jr: Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes. J Neurosurg 2006;104:488–501.
  15. Kupsch A, Kuehn A, Klaffke S, Meissner W, Harnack D, Winter C, Haelbig TD, Kivi A, Arnold G, Einhaupl KM, Schneider GH, Trottenberg T: Deep brain stimulation in dystonia. J Neurol 2003;250(suppl 1):I47–I52.
  16. Kumar R, Dagher A, Hutchison WD, Lang AE, Lozano AM: Globus pallidus deep brain stimulation for generalized dystonia: clinical and PET investigation. Neurology 1999;53:871–874.
  17. Alterman RL, Miravite J, Weisz D, Shils JL, Bressman SB, Tagliati M: Sixty hertz pallidal deep brain stimulation for primary torsion dystonia. Neurology 2007;69:681–688.
  18. Goto S, Mita S, Ushio Y: Bilateral pallidal stimulation for cervical dystonia. An optimal paradigm from our experiences. Stereotact Funct Neurosurg 2002;79:221–227.
  19. Bittar RG, Yianni J, Wang S, Liu X, Nandi D, Joint C, Scott R, Bain PG, Gregory R, Stein J, Aziz TZ: Deep brain stimulation for generalised dystonia and spasmodic torticollis. J Clin Neurosci 2005;12:12–16.
  20. Krauss JK, Loher TJ, Pohle T, Weber S, Taub E, Barlocher CB, Burgunder JM: Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy. J Neurol Neurosurg Psychiatry 2002;72:249–256.
  21. Yianni J, Bain PG, Gregory RP, Nandi D, Joint C, Scott RB, Stein JF, Aziz TZ: Post-operative progress of dystonia patients following globus pallidus internus deep brain stimulation. Eur J Neurol 2003;10:239–247.
  22. Montgomery EB Jr, Baker KB: Mechanisms of deep brain stimulation and future technical developments. Neurol Res 2000;22:259–266.
  23. Vitek JL, Chockkan V, Zhang JY, Kaneoke Y, Evatt M, DeLong MR, Triche S, Mewes K, Hashimoto T, Bakay RA: Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol 1999;46:22–35.
  24. Kavaklis O, Shima F, Kato M, Fukui M: Ipsilateral pallidal control on the sternocleidomastoid muscle in cats: relationship to the side of thalamotomy for torticollis. Neurosurgery 1992;30:724–730.
  25. Thompson ML, Thickbroom GW, Mastaglia FL: Corticomotor representation of the sternocleidomastoid muscle. Brain 1997;120:245–255.
  26. Magyar-Lehmann S, Antonini A, Roelcke U, Maguire RP, Missimer J, Meyer M, Leenders KL: Cerebral glucose metabolism in patients with spasmodic torticollis. Mov Disord 1997;12:704–708.
  27. Naumann M, Pirker W, Reiners K, Lange KW, Becker G, Brucke T: Imaging the pre- and postsynaptic side of striatal dopaminergic synapses in idiopathic cervical dystonia: a SPECT study using [123I]epidepride and [123I]β-CIT. Mov Disord 1998;13:319–323.

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