Factors Influencing the Surgical Decision in Dystonia Patients Referred for Deep Brain Stimulation

Abstract

There is no available data on the journey of dystonia patients once referred to a tertiary center to undergo deep brain stimulation (DBS). We hypothesized that some patients might be incorrectly diagnosed while others might decline the procedure or experience significant benefit with switching to a different botulinum neurotoxin (BoNT). This is a single-center, retrospective study of dystonia patients who were referred to the DBS program between January 2014 and December 2018. We collected data on the surgical decision as well as factors influencing this decision. Sixty-seven patients were included (30 males, mean age: 48.3 ± 20.1 years, disease duration: 16.9 ± 15.3 years). Thirty-three (49%) patients underwent DBS. Four (6%) patients were awaiting the procedure while the remaining 30 patients (45%) did not undergo DBS. Reasons for DBS decline were patient refusal (17, 53%), functional dystonia (6, 20%), and successful use of AbobotulinumtoxinA (3, 10%) in patients who had failed other BoNTs. Our study highlights the importance of structured patient education to increase acceptance of DBS, as well as careful patient evaluation, particularly with respect to functional dystonia. Finally, changing BoNT formulation might be beneficial in some patients.

Keywords: AbobotulinumtoxinA; IncobotulinumtoxinA; OnabotulinumtoxinA; botulinum toxins; deep brain stimulation; dystonia.

Figure 1

Flow diagram of dystonia patients who were seen in the DBS clinic. See text for details. Abbreviations: Abo-A—AbobotulinumtoxinA, DBS—deep brain stimulation, GPi—globus pallidus pars interna; ViM—ventral nucleus of the thalamus.