Pallidal deep brain stimulation in patients with cranial-cervical dystonia (Meige syndrome).

Abstract

Idiopathic cranial-cervical dystonia (ICCD) is an adult-onset dystonia syndrome affecting orbicularis oculi, facial, oromandibular, and cervical musculature. ICCD is frequently difficult to treat medically. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a highly effective treatment for idiopathic generalized dystonia, however less is known about the effect of GPi DBS on ICCD. In this article, we present the results from a pilot study assessing the effect of GPi DBS in a series of patients with ICCD. Six patients underwent bilateral stereotactic implantation of DBS leads into the sensorimotor GPi. Patients were evaluated with the Burke-Fahn-Marsden dystonia rating scale (BFMDRS) and Toronto western spamodic torticollis rating scale (TWSTRS) before surgery and 6 months postoperatively. At 6 months, patients showed a 72% mean improvement in the BFMDRS total movement score (P < 0.028, Wilcoxin signed rank test). The mean BFMDRS disability score showed a trend toward improvement (P < 0.06). The total TWSTRS score improved 54% (P < 0.043). Despite improvement in dystonia, mild worsening of motor function was reported in previously nondystonic body regions with stimulation in 4 patients. Although GPi DBS was effective in these patients, the influence of GPi DBS on nondystonic body regions deserves further investigation.

• Authors: Jill L Ostrem, William J Marks Jr, Monica M Volz, Susan L Heath, Philip A Starr
• Journal: Movement disorders : official journal of the Movement Disorder Society (Mov Disord) Vol. 22 Issue 13 Pg. 1885-91 (Oct 15 2007) ISSN: 0885-3185 [Print] United States
• PMID: 17618522 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
• Copyright: 2007 Movement Disorder Society

Topics

• Adult
• Aged
• Deep Brain Stimulation (adverse effects, instrumentation)
• Electrodes, Implanted
• Female
• Follow-Up Studies
• Globus Pallidus (physiopathology)
• Humans
• Male
• Meige Syndrome (physiopathology, therapy)
• Microcomputers
• Middle Aged
• Neurologic Examination
• Pilot Projects
• Pyramidal Tracts (physiopathology)
• Torticollis (physiopathology, therapy)
• Treatment Outcome