Objective: This case report examines whether deep brain stimulation (DBS) can be considered a viable surgical option for patients with tardive dystonia who show insufficient response to radiofrequency ablation (RF).

Background: Both DBS and RF are known to be effective surgical treatments for dystonia. Despite their differing mechanisms—DBS providing stimulation and RF inducing lesioning—both procedures have demonstrated similar therapeutic effects. Therefore, the selection of an appropriate procedure should be carefully considered based on the patient’s background, disease status, and the advantages and disadvantages of each treatment.

In Japan, many patients hesitate to undergo device implantation, leading to a preference for RF. However, some patients experience limited improvement after RF. This study examines whether DBS could be an effective alternative for such cases.

Method: The patient was a 44-year-old woman who developed retrocollis and truncal extension during treatment for depression. Medication was ineffective, leading to surgical intervention. Staged procedures were performed, including left GPi pallidotomy followed by right pallidothalamic tractotomy. Despite precise targeting, symptom improvement remained limited, prompting bilateral GPi DBS as the next treatment. Symptom changes before and after DBS were assessed using video evaluations and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS).

Results: Following DBS, the patient exhibited significant symptom improvement, as reflected in the BFMDRS score. Several days of continuous stimulation were required to achieve symptom relief. Stimulation settings were bipolar mode using the second-lowest electrode with parameters of 200 μs pulse width, 179 Hz frequency, and 3.0 mA current.

Conclusion: DBS was found to be a potential treatment option for patients who showed insufficient response to RF. Since RF and DBS affect the brain differently, a patient unresponsive to one treatment may still benefit from the other. Additionally, DBS offers adjustable stimulation parameters, allowing for treatment optimization in cases where RF alone was inadequate. Rather than being viewed as entirely separate techniques, RF and DBS may complement each other by compensating for their respective limitations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-case-of-tardive-dystonia-treated-with-bilateral-radiofrequency-ablation-and-deep-brain-stimulation/