Objective: This study aims to evaluate the prognostic significance of dystonic tremor in CD patients undergoing DBS. Specifically, we analyze whether the presence of preoperative DT correlates with improved surgical outcomes and whether the emergence of DT in previously non-tremor tonic patients postoperatively is associated with better long-term prognosis.

Background: Cervical dystonia (CD) is a movement disorder characterized by involuntary muscle contractions leading to abnormal postures and movements of the neck. Among CD patients, the presence of dystonic tremor (DT) is a common feature, but its impact on surgical outcomes remains underexplored. Deep brain stimulation (DBS) is a well-established therapeutic option for CD, yet the long-term prognosis in relation to preoperative and postoperative tremor characteristics has not been thoroughly investigated.

Method: A retrospective analysis was conducted on 129 patients who underwent DBS for CD between September 2011 and February 2024. Patients were categorized into three groups: those with preoperative DT (83 patients), those without preoperative DT but developed DT postoperatively (12 patients), and those who remained tonic or phasic without DT postoperatively (34 patients). Clinical outcomes were assessed using standardized dystonia severity and functional disability scales. Statistical analysis was performed to determine the correlation between DT and long-term surgical outcomes.

Results: Patients with preoperative DT demonstrated significantly better long-term improvement following DBS compared to those without preoperative DT (p<0.05). Furthermore, among the patients who initially presented with tonic CD, those who developed postoperative DT exhibited a more favorable prognosis compared to those who remained purely tonic (p<0.05). This suggests that DT may serve as a marker of a responsive phenotype to DBS intervention.

Conclusion: The presence of dystonic tremor in CD patients is associated with better surgical outcomes following DBS. Moreover, the emergence of postoperative DT in previously tonic patients may indicate a favorable trajectory. These findings highlight the need for further investigation into the neurophysiological mechanisms linking dystonia and tremor, as well as their implications for optimizing patient selection and treatment strategies in DBS for CD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dystonic-tremor-as-a-prognostic-marker-of-deep-brain-stimulation-success-in-cervical-dystonia/