- See Dystonia
- Indicated for
- Generalized and segmental primary (inherited and idiopathic) dystonia
- Cervical dystonia
- Some childhood generalized dystonias (first line)
- Medical refractory
- Symptoms disabling enough to justify surgical risk
- Botulinum toxin refractory
- CI
- If pallidium is damage DBS unlikely to work
- Anoxia damage
- Post Traumatic dystonia
- Target
- Posteroventral lateral GPi
- Side effects
- Bradykinesia and gait problems (unsure mech)
- There are encouraging results in (outcome of DBS is usually excellent, rapid and sustained-up to 10 yrs)
- Cervical dystonia,
- Myoclonus-dystonia
- Tardive dystonia
- Researched
- STN
- Thalamus
- Sensorimotor thalamus
- VIM for more tremor
- Not sure which part of the ventrolateral thalamus is the best to stimulate
- The anterior (that is, the Voa according to Hassler),
- Posterior (the Vim)
- Intermediate regions (the region formerly termed Vop).
- Outcome
- Symptoms may take months to improve
- Best prognostic factor
- DYT1 better outcome than DYT2 gene
- Younger age
- Shorter duration of symptoms
- Lack of psychiatric / psychological co-morbidities
- If stimulated for long it can cause chronic changes that when the DBS is off the therapeutic effects of DBS is still seen for weeks → possible that DBS modulate disease progression → need future study to see if DBS early can be more beneficial (another EARLYSTIM trial for dystonia)
- Dystonia emergencies related to DBS
- Sudden DBS failure
- Risk of dystonic crisis “status dystonicus”/ rhabdomyolysis etc morbidity +++
- Admit to HDU if has generalised dystonia, especially if genetic
- Speak to neurology + ICU teams.
- Supportive management. Drugs: baclofen/benzodiazepines/ anticholinergics etc +- sedation with propofol
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