Deep brain stimulation for primary generalized dystonia: long-term outcomes

Ioannis U Isaias, Ron L Alterman, Michele Tagliati
Archives of Neurology 2009, 66 (4): 465-70

BACKGROUND: Pallidal deep brain stimulation (DBS) is the best therapeutic option for patients with disabling primary generalized dystonia (PGD) that is refractory to medications. However, little is known about its long-term effects.

OBJECTIVE: To describe long-term clinical outcomes in patients with PGD who underwent pallidal DBS.

DESIGN: Case series.

SETTING: University hospital.

PATIENTS: Thirty consecutive patients with at least 2 years' follow-up after pallidal DBS for intractable PGD.

INTERVENTIONS: Pallidal DBS and annual follow-up examinations up to 8 years after DBS implantation.

MAIN OUTCOME MEASURES: Clinical outcome as measured by changes in the Burke-Fahn-Marsden dystonia scale, incidence and prevalence of adverse events, total electrical energy delivered, and implantable pulse generator longevity.

RESULTS: Twenty-three patients were followed for 3 years, 13 for 4 years, 9 for 5 years, 5 for 6 years, 5 for 7 years, and 1 for 8 years after DBS. Overall improvement at 1 year was maintained in all at successive yearly examinations. There were no intraoperative complications; hardware-related adverse events were infrequent. Rare stimulation-related adverse events primarily affected speech. Implantable pulse generators were replaced every 24 months on average in patients who received initial stimulation at 130-Hz frequency. No battery was replaced, for up to 48 months, in 20 patients initially stimulated using 60 Hz. Clinical outcome did not depend on high energies of stimulation.

CONCLUSIONS: Pallidal DBS is a safe and effective treatment for PGD, with improvement sustained for up to 8 years in 1 patient. Low energies of stimulation, although they did not affect clinical outcome, were associated with longer battery life.

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