Journal Article

The Canadian multicentre study of deep brain stimulation for cervical dystonia

Zelma H. T. Kiss, Kristina Doig-Beyaert, Michael Eliasziw, Joseph Tsui, Angela Haffenden and Oksana Suchowersky

in Brain

Published on behalf of The Guarantors of Brain

Volume 130, issue 11, pages 2879-2886
Published in print November 2007 | ISSN: 0006-8950
Published online September 2007 | e-ISSN: 1460-2156 | DOI: http://dx.doi.org/10.1093/brain/awm229
The Canadian multicentre study of deep brain stimulation for cervical dystonia

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Deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) is an effective treatment for generalized dystonia. Its role in the management of other types of dystonia is uncertain. Therefore we performed a prospective, single-blind, multicentre study assessing the efficacy and safety of bilateral GPi-DBS in 10 patients with severe, chronic, medication-resistant cervical dystonia. Two blinded neurologists assessed patients before surgery and at 6 and 12 months post-operatively using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The primary outcome measure was the severity subscore (range 0–30, higher scores indicating greater impairment). Secondary outcomes included disability (0 to 30), pain (0 to 40) subscores and total scores of the TWSTRS, Short Form-36 and Beck depression inventory. Swallowing and neuropsychological assessment were also performed at baseline and 12 months. One-way repeated measures analysis of variance was used to analyse the data.

The TWSTRS severity score improved from a mean (SD) of 14.7 (4.2) before surgery to 8.4 (4.4) at 12 months post-operatively (P = 0.003). The disability and pain scores improved from 14.9 (3.8) and 26.6 (3.6) before surgery, to 5.4 (7.0) and 9.2 (13.1) at 12 months, respectively (both P < 0.001). General health and physical functioning as well as depression scores improved significantly. Complications were mild and reversible in four patients. Some changes in neuropsychological tests were observed, although these did not impact daily life or employment. Our results support the efficacy and safety of GPi-DBS for the treatment of patients with severe and prolonged cervical dystonia who have failed medical management.

Keywords: dystonia; torticollis; deep brain stimulation; clinical trial; globus pallidus; high-frequency stimulation

Journal Article.  4540 words.  Illustrated.

Subjects: Neurology ; Neuroscience

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