Objective: Among patients diagnosed with dystonia, initial improvement after surgery can fade away. The authors analyzed the effectiveness and safety of a second or third surgical approach that include ablative procedures or deep brain stimulation (DBS) in the treatment for of generalized dystonia (GD).

Background: Ablative procedures like thalamotomy and pallidotomy remained the primary stereotactic treatment methods for GD until recently. Today the DBS has become a standard  surgical tool for various movement disorders treatment that include GD. Complex neuromodulative treatment can be implemented to achieve better clinical results.

Method: 14 GD patients with the history of bilateral GPi DBS or thalamotomy, or pallidotomy were qualified for a second or third stage surgical treatment. The whole group demonstrated significant clinical improvement that faded away six months to eleven years  after initial surgery. 7 of them, who underwent ablative procedures in the past were qualified for DBS: GPi (3 patients) and STN (4 patient). Four patients, who underwent GPi stimulation in past received additional STN DBS treatment. 4 patients who underwent unilateral thalamotomy and bilateral GPi DBS received additionally STN DBS.

Results: The complex neuromodulative treatment that included multimodal and multifocal DBS caused sustained improvement in dystonic movement in the whole group. The improvement measured with Unified Dystonia Rating Scale (UDRS) lasted from two years to 11 years follow-up.  No surgical or stimulation related complications were reported.

Conclusion: Combined neuromodulative treatment of dystonia: should be considered when dystonic symptoms aggravate over time.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/combined-neuromodulative-treatment-of-generalized-dystonia/