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. 2020 Jan:70:82-93.
doi: 10.1016/j.parkreldis.2019.11.016. Epub 2019 Nov 18.

Quality of life outcomes after deep brain stimulation in dystonia: A systematic review

Takashi Tsuboi  1 , Joshua K Wong  2 , Michael S Okun  2 , Adolfo Ramirez-Zamora  2
Affiliations

Quality of life outcomes after deep brain stimulation in dystonia: A systematic review

Takashi Tsuboi et al. Parkinsonism Relat Disord. 2020 Jan.

Abstract

Dystonia is an incurable movement disorder which can cause not only physical but also mental problems, leading to impaired health-related quality of life (HRQoL). For patients with dystonia refractory to medical treatment, deep brain stimulation (DBS) is a well-established surgical treatment. The objective of this systematic review is to provide a better understanding of HRQoL outcomes after DBS for dystonia. A search of the literature was conducted using Medline (PubMed), Embase, and Cochrane Library databases in May 2019. HRQoL outcomes after DBS along with motor outcomes were reported in a total of 36 articles involving 610 patients: 21 articles on inherited or idiopathic isolated dystonia, 5 on tardive dystonia, 3 on cerebral palsy, 2 on myoclonus-dystonia, 1 on X-linked dystonia-parkinsonism, and 3 on mixed cohorts of different dystonia subtypes. DBS improved motor symptoms in various subtypes of dystonia. Most studies on patients with inherited or idiopathic isolated dystonia showed significant improvement in physical QoL, whereas gains in mental QoL were less robust and likely related to the complexity of associated neuropsychiatric problems. HRQoL outcomes beyond 5 years remain scarce. Although the studies on patients with other subtypes of dystonia also demonstrated improvement in HRQoL after DBS, the interpretation is difficult because of a limited number of articles with small cohorts. Most articles employed generic measures (e.g. Short Form Health Survey-36) and this highlights the critical need to develop and to utilize sensitive and disease-specific HRQoL measures. Finally, long-term HRQoL outcomes and predictors of HRQoL should also be clarified.

Keywords: Deep brain stimulation; Dystonia; Quality of life.

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Conflict of interest statement

Financial disclosures

T.T. and J.K.W. declare no competing interests. M.S.O. serves as a consultant for the National Parkinson Foundation, and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. M.S.O.‘s DBS research is supported by: R01 NR014852 and R01NS096008. M.S.O. has previously received honoraria, but in the past > 60 months has received no support from industry. M.S.O. has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, and Cambridge (movement disorders books). M.S.O. is an associate editor for New England Journal of Medicine Journal Watch Neurology. M.S.O. has participated in CME and educational activities on movement disorders (in the last 36) months sponsored by PeerView, Prime, QuantiaMD, WebMD, Medicus, MedNet, Henry Stewart, and by Vanderbilt University. The institution and not M.S.O. receives grants from Medtronic, Abbvie, Allergan, and ANS/St. Jude, and the PI has no financial interest in these grants. M.S.O. has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria. A.R.Z serves as a consultant for the National Parkinson Foundation and has received research consulting honoraria from Medtronic and Bracket.

Figures

Fig. 1.
Fig. 1.
Flow diagram of review process.
See this image and copyright information in PMC

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