Category: Dystonia: Clinical Trials and Therapy
Objective: Managing generalized dystonia in adults is challenging despite pharmacological interventions due to suboptimal response or intolerable side effects. While bilateral Globus Pallidus internus Deep Brain Stimulation effectively alleviates dystonic symptoms, limited documentation exists on the benefits of unilateral stimulation. This case report presents successful treatment of generalized dystonia using unilateral GPi-DBS due to suboptimal lead placement.
Background: DBS has replaced unilateral pallidotomy for managing generalized dystonia. Limited evidence exists for unilateral stimulation’s efficacy, but positive results were reported in combining unilateral GPi-DBS with contralateral GPi lesions and unilateral STN stimulation.
Method: We present a 48-year-old female patient, no family history, with progressive generalized dystonia exhibited predominant axial dystonia with marked trunk hyperextension, causing mobility impairment and social withdrawal. Oral medications and botulinum toxin injections were ineffective. She was submitted to bilateral GPI-DBS implantation. Left lead stimulation resulted in side effects, indicating misplacement. We deactivated the left lead and right lead’s parameters were optimized.
Results: Despite unilateral stimulation, the patient experienced remarkable improvements in mobility and overall functionality. Over a six-year follow-up, the patient expressed satisfaction with unchanged therapy. No new neurological complaints were reported. Pre-DBS BFMDRS score was 79/120, improving to 20/120 post-DBS and remaining stable.
Conclusion: The precise impact of unilateral stimulation and potential microlesions on the left GPi is uncertain. Microlesion effects are temporary, suggesting minimal influence on dystonia. Alternatively, motor benefits may persist after DBS interruption, especially in younger patients. The brief period between symptom onset and surgery and the dystonia type likely contributed to the optimal therapeutic unilateral stimulation response. Unilateral GPi-DBS offers advantages such as cost-effectiveness and reduced invasiveness. Randomized controlled studies comparing unilateral and bilateral DBS are still lacking. It could offer a viable option, particularly for patients with prominent axial symptoms or previously submitted to another procedure unilaterally. Finally, it could address challenges faced in regions with limited DBS resources.
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To cite this abstract in AMA style:
K. Massruha, I. Brum, C. Listik, J. Yamamoto, S. Casagrande, M. Belo Silva, P. Medeiros Lacerda, V. Zanesi Maciel, R. Cury, E. Barbosa. Effective Management of Generalized Dystonia with Unilateral Deep Brain Stimulation – Killing Two Birds with One Stone? [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/effective-management-of-generalized-dystonia-with-unilateral-deep-brain-stimulation-killing-two-birds-with-one-stone/. Accessed October 15, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/effective-management-of-generalized-dystonia-with-unilateral-deep-brain-stimulation-killing-two-birds-with-one-stone/