Objective: To review the use of bipolar and monopolar stimulation in a cohort of patients implanted DBS with Generalized Dystonia between 2012-2021 in Federal Center of Neurosurgery (FCN), Tyumen, Russia.

Background: The inner Globus Pallidum (GPi) should be targeted for effective DBS in Generalized Dystonia (GD). Several randomized controlled trials have demonstrated a sustained improvement in patients with generalized dystonia following DBS, as shown by lower motor and functional scores on the BFMDS.1 After 5 years of DBS, generalized dystonia is reported to show a reduction in the BFMDS scale score of 42%–61%.2

Method: Medical records from all GD patients that underwent surgery for GPi-DBS between 2012-2021 at the FCN Tyumen were reviewed. Demographic data and stimulation parameters were assessed at minimum 3-month follow-upvisit (MFU, range 3-12 months after surgery) and at last follow-up(LFU). The patients who cannot come to the in person check-out was examinated via video calls, all programming were made by nearest neurologist to patient with DBS programmer and coordinated with FCN and has been rated by BFMDS on the “on” and “off” state of IPG. In LFU (including online) all patients has been rated by BFMDS on the “on” and “off” state of IPG.

Results: Between 2012 and 2021, 66 GD patients were implanted with segmented leads targeted at the GPi (33f, 33 male, 34,4 years) in our centre. Mean age – 34,4 (5-71). From 66 patients 5 DBS systems was infected and removed, after, 2 patients were re-implanted. Last follow-up occurred on average 25 months after surgery. In total, 69.8% (44/63) had monopolar programming settings at the 6 MFU (i.e. 19/63 bipolar mode 30.2%). At LFU patients who had monopolar stimultion had average score in BFMDS In “off” IPG was 82,43., “on” 13,21. In bipolar stimulation BFMDS In “off” IPG was 83,1., “on” 17,8.

Conclusion: We present data from a GD cohort of DBS implanted patients at our centre between 2012-2021. Patient ratio of monopolar and bipolar mode stimulation was 69,8% to 30,2% and this proportion was sustained at last follow-up. Our results show  that  there is no significant clinical difference in BFMDS between monopolar and bipolar stimulation in LFU. However, this study shoved only dystonia state in current time. Further investigations should be proceed in prospective taking into account patients quality of life and movements in order to programming settings such as pulse amplitude, frequency and width.

References: 1. Kupsch A, Benecke R, Müller J, Trottenberg T, Schneider GH, Poewe W, et al: Pallidal DBS in primary generalized or segmental dystonia. N Engl J Med 355:1978–1990, 2006.
2. Brüggemann N, Kühn A, Schneider SA, Kamm C, Wolters A, Krause P, et al: Short and long-term outcome of chronic pallidal neurostimulation in monogenic isolated dystonia. Neurology 84:895–903, 2015.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/short-report-in-a-dystonia-cohort-patients-with-implanted-dbs-systems/