Unilateral globus pallidus internus combined contralateral subthalamic nucleus deep brain stimulation in the treatment of cervical dystonia: a case report and literature review

Abstract

Background: Deep brain stimulation (DBS) is an effective treatment modality for medication-refractory cervical dystonia (CD). In recent years, the asymmetric targets for lead implantation of DBS have become a more valued topic. Objectives: To explore the efficacy of the asymmetric targets for lead implantation of DBS. Methods: A patient with CD underwent unilateral globus pallidus internus (GPi) combined contralateral subthalamic nucleus (STN) deep brain stimulation. Results: Although neither unilateral GPi nor STN stimulation relieved the patient’s clinical symptoms during temporary testing after surgery, the positive effect of bilateral stimulation was substantial. At the 12-month postoperative evaluation, the patient’s clinical symptoms improved remarkably, with an improvement rate of 78% compared with the preoperative assessment. Conclusions: Combined with the previous kinds of literature we reviewed in this article, we propose that in addition to conventional lead implantation, the option of using asymmetric targets for lead implantation can be considered when physicians encounter special conditions and can also be effective in relieving clinical symptoms in patients with CD.