Objective: To study the influence of psychiatric disorders on the outcome of deep brain stimulation (DBS) for cervical dystonia (CD).

Background: DBS is an established treatment for botulinum toxin injection refractory CD. However, patient satisfaction after surgery is heterogeneous. Given the association between CD and psychiatric disorders, these might play a role in clinical manifestation and outcome.

Method: A cohort of 49 patients with CD who underwent DBS was studied in two centers. A history of possible psychiatric disorders was derived from the patient files. Pre- and post-operative Toronto Western Spasmodic Torticollis Rating Scores (TWSTRS, range 0-85) were compared between patients with and without a psychiatric history.

Results: The proportion of patients with a psychiatric history in the cohort was 40.8%. The mean (±SD) improvement of the cohort was 38.0±29.2% on the total TWSTRS score. At baseline, the patients with a psychiatric history compared to the patients without a psychiatric history had similar mean severity (19.5±5.6 vs 19.1±4.0; p=1.00) and disability scores (19.5±5.5 vs 16.6±5.0; p=0.09). At baseline, patients with a psychiatric history had significantly higher pain scores (median 14.4 [IQR 3.9] vs 11.8 [IQR 6.6]; p=0.01).

Post-operatively, mean motor improvement tended to be larger in patients with a psychiatric history compared to patients without a psychiatric history (46.7%±38.9% vs 32.01%±34.7%; p=0.14). Whereas disability (38.0%±42.1% vs 54.2%±37.3%; p=0.10) and pain scores (median 28.7% [IQR 41,8%] vs 45.7% [IQR 75.7%]; p<0.01) improved less in the group with a psychiatric history. Patients with a psychiatric history respond proportionally more in terms of motor outcome (severity) than non-motor outcome (disability and pain) with a ratio of 0.57 vs 0.83 (p<0.001).

Conclusion: In our cohort, a large portion of CD patients had a history of psychiatric disorders. We found similar improvements following DBS for CD compared to the literature. Pre-operatively, patients with a psychiatric history experienced more pain and in this group disability and pain improved slightly less following DBS.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cervical-dystonia-patients-with-psychiatric-disorders-show-more-motor-and-less-non-motor-improvement-after-dbs-surgery/