Deep brain stimulation for dystonia

Abstract

Deep brain stimulation (DBS) is an effective surgical treatment for medication-refractory movement disorders, and has been approved by the United States Food and Drug Administration for treatment of dystonia. The success of DBS in the treatment of dystonia depends on our understanding of the anatomy and physiology of this disorder and close collaboration between neurosurgeons, neurologists, clinical neurophysiologists, neuroradiologists and neuropsychologists. Currently, pallidal DBS is an established treatment option for medically refractive dystonia. This review is intended to provide a comprehensive review of the use of DBS for dystonia, focusing mainly on the surgical aspects, clinical outcome, MRI findings and side effects of DBS.

Figure 1

Postoperative magnetic resonance images for the targets of bilateral Globus Pallidus Pars Interna from a representative patient. (A) T1-weighted and (B) T2-weighted axial sequences are shown with the target highlighted with black dots.

Figure 2

Computer-aided subtraction SPECT imaging in a patient with severe dystonia. The patient was 35 years old with long history of cervical dystonia and choreoathetotic movements. We obtained Technetium 99 m Neurolite SPECT scan of the brain in this patient with awake state and under anesthesia, respectively. Subtraction SPECT imaging had shown a hypermetabolic left caudate (blue), which is helpful for DBS target selection.