Yonsei Med J.  2022 Feb;63(2):166-172. 10.3349/ymj.2022.63.2.166.

Dual Pallidal and Thalamic Deep Brain Stimulation for Complex Ipsilateral Dystonia

• Chang KW
• Kim MJ
• Park SH
• Chang WS
• Jung HH
• Chang JW

• KMID: 2525260
• DOI: http://doi.org/10.3349/ymj.2022.63.2.166

Abstract

Purpose
Globus pallidus pars interna (GPi) has become an established target for deep brain stimulation (DBS) in dystonia. Previous studies suggest that targeting the ventralis oralis (Vo) complex nucleus improves dystonic tremor or even focal dystonia. Research has also demonstrated that multi-target DBS shows some benefits over single target DBS. In this study, we reviewed patients who had undergone unilateral DBS targeting the GPi and Vo.
Materials and Methods
Five patients diagnosed with medically refractory upper extremity dystonia (focal or segmental) underwent DBS. Two DBS electrodes each were inserted unilaterally targeting the ipsilateral GPi and Vo. Clinical outcomes were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Disability Rating Scale.
Results
BFMDRS scores decreased by 55% at 1-month, 56% at 3-month, 59% at 6-month, and 64% at 12-month follow up. Disability Rating Scale scores decreased 41% at 1-month, 47% at 3-month, 50% at 6-month, and 60% at 12-month follow up. At 1 month after surgery, stimulating both targets improved clinical scores better than targeting GPi or Vo alone.
Conclusion
Unilateral thalamic and pallidal dual electrode DBS may be as effective or even superior to DBS of a single target for dystonia. Although the number of patients was small, our results reflected favorable clinical outcomes.

Keyword

Dystonia; deep brain stimulation; ventralis oralis; globus pallidus; multi target dbs