Surgical treatment of dystonia

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.

KEYWORDS:

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

Declaration of interest

E Moro has received honoraria for lecturing from Medtronic and Bial and scientific board services from Medtronic. E Moro has also received research grant support from Merz. RG Cury has received honoraria from Medtronic for lecturing. J Jimenez-Shahed has received consulting fees and research support from Abbott and Medtronic. LK Prashanth has received honoraria from Merz India, Allergan, & Medtronic, for lecturing and scientific board services. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

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Funding

This paper was not funded.