Objective: To study the efficacy of GPi DBS surgery in improving dystonia related severity, disability and pain as well as quality of life in medically intractable primary cervical dystonia.

Background: Deep Brain Stimulation is regarded as an effective treatment for medically intractable primary cervical dystonia, in particular alleviating symptoms of dystonia severity as rated by TWISTER. The effect of surgery on pain, perceived disability and quality of life is however more complex. Studies have demonstrated that pain, and other non motor features such as depression, are common and have a direct effect on quality of life in patients with cervical dystonia. Whilst Botulinum toxin treatment seems to have excellent results in dystonia pain improvement (in 60-90 % of CD patients), surgery tends to be used in patients whose dystonia is severe and intractable to medical therapy.

Methods: A retrospective analysis of the TWISTER (severity, disability and pain sub-scores) and a QoL score (EQ5d) at baseline and 12 months post op was carried out in seventeen patients who underwent Gpi-DBS.

Results: There were 6 males and 11 females, average age 60 and average disease duration of 11.88 years. There was a 5 points (34.86 %), p=0.001 improvement in TWISTER dystonia severity sub score. 3 points (14.98 %), p=0.02 improvement in the disability sub score and, 4.5 points (23.11 %), p=0.0042 improvement in the pain score. Quality of life improvement was 0.06 % (not significant).

Conclusions: The response of pain, disability and quality of life to this type of surgery seems to be less impressive than that of physical symptoms severity improvement. This can be partly explained by selection bias, i.e. this group of patients have more severe disease, with worse non motor symptoms and longer disease duration and partly because the operation has less effect on the other determinants of quality of life. The dystonia patients’ expectations from therapy may also play a role. References: 1. Cervical Dystonia and Pain: characteristics and treatment patterns from CD PROBE, Charles PD, Alder CH, Stacy M et al. J Neurol 2014 Jul;261(7):1309-19. 2. Factors affecting the health-related quality of life of patients with cervical dystonia and the impact of botulinum toxin type A injections. Slawek J, Friedman A, Potulska A, et al. J Neurol. 2015;262(4):837-48.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/does-gpi-dbs-help-non-motor-symptoms-in-cervical-dystonia-patients-a-retrospective-study-of-17-patients/