Primary Dystonia Is More Responsive than Secondary Dystonia to Pallidal Interventions: Outcome after Pallidotomy or Pallidal Deep Brain Stimulation

Author:

Eltahawy Hazem A.12,Saint-Cyr Jean1,Giladi Nir3,Lang Anthony E.4,Lozano Andres M.1

Affiliation:

1. Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada

2. Department of Neurosurgery, Ain Shams University Hospitals, Cairo, Egypt

3. Movement Disorders Unit, Department of Neurology, Sackler Faculty of Medicine, Tel Aviv, Israel

4. Division of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada

Abstract

Abstract OBJECTIVE The response of patients with dystonia to pallidal procedures is not well understood. In this study, we assessed the postoperative outcome of patients with primary and secondary dystonia undergoing pallidotomy or pallidal deep brain stimulation. METHODS Fifteen patients with dystonia had pallidal surgery (lesions or deep brain stimulation). These included nine patients with primary dystonia (generalized and cervical dystonias) and six with secondary dystonia (generalized, segmental, and hemidystonias). There were nine male patients and six female patients. The mean age at onset was 21 years for primary dystonia and 18 years for secondary dystonia. The primary outcome measure was a Global Outcome Scale score for dystonia at 6 months after surgery. Other outcome measures were the Burke-Fahn-Marsden Dystonia Rating Scale and Toronto Western Spasmodic Torticollis Rating Scale scores. RESULTS The mean Global Outcome Scale score at 6 months for patients with primary dystonia was 3 (improvement in both movement disorder and function). In contrast, patients with secondary dystonia had a mean score of 0.83 (mild or no improvement in movement disorder with no functional improvement). All patients with primary dystonia had normal brains by magnetic resonance imaging, whereas five of six patients with secondary dystonia had basal ganglia abnormalities on their magnetic resonance imaging scans. CONCLUSION This study indicates that primary dystonia responds much better than secondary dystonia to pallidal procedures. We could not distinguish a difference in efficacy between pallidotomy and pallidal deep brain stimulation. The presence of basal ganglia abnormalities on the preoperative magnetic resonance imaging scan is an indicator of a lesser response to pallidal interventions for dystonia.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

Reference46 articles.

1. Bilateral pallidal deep brain stimulation for cervical and truncal dystonia;Andaluz;Neurology,2001

2. Stereotaxic thalamotomy in 55 cases of dystonia;Andrew;Brain,1983

3. Surgical palliation of dyskinesiae in Parkinson's disease;Brophy;Stereotact Funct Neurosurg,1998

4. Validity and reliability of a rating scale for the primary torsion dystonias;Burke;Neurology,1985

5. Outcome after stereotactic thalamotomy for dystonia and hemiballismus;Cardoso;Neurosurgery,1995

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