Objective: To evaluate the utility and safety of deep brain stimulation (DBS) of the globus pallidus internus (GPi) combined with bilateral anterior capsulotomy in the treatment of tardive dystonia in patients with treatment-refractory schizophrenia.

Background: Tardive dystonia is frequently observed among patients with schizophrenia. Many studies have shown that DBS of the GPi is effective in improving refractory tardive dystonia, but that this treatment has no or limited effects on psychiatric symptoms. By contrast, bilateral anterior capsulotomy has been found to relieve the symptoms of otherwise treatment-refractory schizophrenia.

Methods: From 2006 to 2016, 5 patients with tardive dystonia and refractory schizophrenia received bilateral GPi-DBS combined with bilateral anterior capsulotomy. Patients were assessed before surgery (baseline) and at 1-week post-surgery, 6-month post-surgery, and at a long-term follow-up (ranging from 24 to 120 months after surgery). We used several validated clinical outcome measures, including the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) to measure dystonia, the Positive and Negative Syndrome Scale (PANSS) to measure schizophrenia symptoms severity, the Brief Psychiatric Rating Scale (BPRS) to measure psychiatric symptoms severity, and the Short Form Health Survey (SF-36) to measure quality of life.

Results: Relative to baseline, the BFMDRS motor scores of patients were improved by 59% at 1-week follow-up, by 89% at 6-month follow-up, and by 95% at last follow-up; BFMDRS disability scores were improved by 61%, 88% and 95%, respectively. Additionally, the BPRS scores showed an improvement at last follow-up; PANSS scores also improved, but these improvements only approached statistical significance. Moreover, quality of life, as indexed by the SF-36, was significantly improved at 6-month follow-up; quality of life remained stable from 2 to 10 years after surgery. Furthermore, at 6-month follow-up, the intake of antipsychotic medications was reduced by 53%. No significant side effects or complications were observed in this group of patients.

Conclusions: This case series indicates that bilateral GPi-DBS combined with bilateral anterior capsulotomy is an effective and relatively safe treatment for patients with tardive dystonia and refractory schizophrenia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-of-globus-pallidus-internus-combined-with-bilateral-anterior-capsulotomy-for-the-treatment-of-tardive-dystonia-in-patients-with-refractory-schizophrenia/