Selective peripheral denervation for cervical dystonia: long-term follow-up.

Abstract

OBJECTIVE:

61 procedures with selective peripheral denervation for cervical dystonia were retrospectively analysed concerning surgical results, pain, quality of life (QoL) and recurrences.

METHODS:

The patients were assessed with the Tsui torticollis scale, Visual Analogue Scale (VAS) for pain and Fugl-Meyer scale for QoL. Evaluations were performed preoperatively, early postoperatively, at 6 months, then at a mean of 42 (13-165) months. All patients underwent electromyogram at baseline, which was repeated in cases who presented with recurrence of symptoms after surgery.

RESULTS:

Six months of follow-up was available for 55 (90%) of the procedures and late follow-up for 34 (56%). The mean score of the Tsui scale was 10 preoperatively. It improved to 4.5 (p<0.001) at 6 months, and 5.3 (p<0.001) at late follow-up. VAS for pain improved from 6.5 preoperatively to 4.2 (p<0.001) at 6 months and 4 (p<0.01) at late follow-up. The Fugl-Meyer score for QoL improved from 43.3 to 46.6 (p<0.05) at 6 months, and to 51.1 (p<0.05) at late follow-up. Major reinnervation and/or change in the dystonic pattern occurred following 29% of the procedures, and led in 26% of patients to reoperation with either additional denervation or pallidal stimulation.

CONCLUSIONS:

Selective peripheral denervation remains a surgical option in the treatment of cervical dystonia when conservative measures fail. Although the majority of patients experience a significant relief of symptoms, there is a substantial risk of reinnervation and/or change in the pattern of the cervical dystonia.

• Authors: A Tommy Bergenheim, Erik Nordh, Eva Larsson, Marwan I Hariz
• Journal: Journal of neurology, neurosurgery, and psychiatry (J Neurol Neurosurg Psychiatry) Vol. 86 Issue 12 Pg. 1307-13 (Dec 2015) ISSN: 1468-330X [Electronic] England
• PMID: 25362089 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Topics

• Adult
• Aged
• Electric Stimulation Therapy
• Electromyography
• Female
• Follow-Up Studies
• Globus Pallidus
• Humans
• Male
• Middle Aged
• Muscle Denervation (methods)
• Neurosurgical Procedures (adverse effects, methods)
• Pain (diagnosis, etiology)
• Pain Measurement
• Peripheral Nerves (surgery)
• Quality of Life
• Recurrence
• Retrospective Studies
• Torticollis (surgery)
• Treatment Outcome