Surgical treatment of dystonia

Rubens Gisbert Cury, Suneil Kumar Kalia, Binit Bipin Shah, Joohi Jimenez-Shahed, Lingappa Kumar Prashanth, Elena Moro

Research output: Contribution to journalReview articlepeer-review

34 Scopus citations

Abstract

Introduction: Treatment of dystonia should be individualized and tailored to the specific needs of patients. Surgical treatment is an important option in medically refractory cases. Several issues regarding type of the surgical intervention, targets, and predict factors of benefit are still under debate. Areas covered: To date, several clinical trials have proven the benefit and safety of deep brain stimulation (DBS) for inherited and idiopathic isolated dystonia, whereas there is still insufficient evidence in combined and acquired dystonia. The globus pallidus internus (GPi) is the target with the best evidence, but data on the subthalamic nucleus seems also to be promising. Evidence suggests that younger patients with shorter disease duration experience greater benefit following DBS. Pallidotomy and thalamotomy are currently used in subset of carefully selected patients. The development of MRI-guided focused ultrasound might bring new options to ablation approach in dystonia. Expert commentary: GPi-DBS is effective and safe in isolated dystonia and should not be delayed when symptoms compromise quality of life and functionality. Identifying the best candidates to surgery on acquired and combined dystonias is still necessary. New insights about pathophysiology of dystonia and new technological advances will undoubtedly help to tailor surgery and optimize clinical effects.

Original languageEnglish
Pages (from-to)477-492
Number of pages16
JournalExpert Review of Neurotherapeutics
Volume18
Issue number6
DOIs
StatePublished - 3 Jun 2018
Externally publishedYes

Keywords

  • Ablative surgery
  • deep brain stimulation
  • dystonia
  • focused ultrasound
  • pallidotomy
  • thalamotomy

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