High frequency
deep brain stimulation (DBS) of the internal portion of the globus pallidus has, in the last two decades, become a mainstream
therapy for the management of medically-refractory
dystonia syndromes. Such increasing uptake places an onus on
movement disorder physicians to become familiar with this treatment modality, in particular optimal patient selection for the procedure and how to troubleshoot problems relating to sub-optimal efficacy and
therapy-related side effects.
Deep brain stimulation for dystonic conditions presents some unique challenges. For example, the frequent lack of immediate change in clinical status following stimulation alterations means that programming often relies on personal experience and local practice rather than real-time indicators of efficacy. Further,
dystonia is a highly heterogeneous disorder, making the development of unifying guidelines and programming algorithms for DBS in this population difficult. Consequently, physicians may feel less confident in managing DBS for
dystonia as compared to other indications e.g.
Parkinson's disease. In this review, we integrate our years of personal experience of the programming of DBS systems for
dystonia with a critical appraisal of the literature to produce a practical guide for troubleshooting common issues encountered in patients with
dystonia treated with DBS, in the hope of improving the care for these patients.