Table 1.
Evidence of Efficacy for Brain Stimulation in Dystonia. For each type of brain stimulation studied in each type of dystonia, we list the percent improvement in dystonia severity, number of patients studied (N), and quality of the evidence per AAN criteria (level B = probably effective; level C = possibly effective; level U = indeterminate). DBS = deep brain stimulation, ECS = electrical ‘subdural’ cortical stimulation, TMS = transcranial magnetic stimulation, tDCS = transcranial direct current stimulation, STN = subthalamic nucleus, Gpi = globus pallidus pars interna.
| Type of Dystonia | Stimulation | % Improvement | N | Evidence | References |
|---|---|---|---|---|---|
| Generalized / Segmental | |||||
| DYT-1 | DBS-Gpi | 73 | 138 | B | (Andrews et al., 2010*; Panov et al., 2013) |
| Non DYT-1 | DBS-Gpi | 56 | 147 | B | (Andrews et al., 2010*) |
| DYT-6 | DBS-Gpi | 40 | 11 | U | (Groen et al., 2010; Panov et al., 2012) |
| Gen / Segmental | DBS-STN | 89 | 12 | U | (Sun et al., 2007) |
| Segmental | TMS | 56 | 1 | U | (Allam et al., 2007) |
| Cervical | |||||
| Cervical | DBS-Gpi | 42 | 129 | B | (Volkmann et al., 2014) |
| Cervical | DBS-STN | 54 | 15 | C | (Ostrem et al., 2011; Schjerling et al., 2013) |
| Cervical | ECS | 16 | 5 | U | (Lalli et al., 2012) |
| Focal Hand | |||||
| Writers Cramp | DBS-Gpi | 92 | 6 | U | (Andrews et al., 2010*) |
| Writers Cramp | TMS | 15 | 28 | U | (Borich et al., 2009; Murase et al., 2005; Siebner et al., 1999) |
| Focal Hand | tDCS | 12 | 26 | U | (Benninger et al., 2011; Buttkus et al., 2010; Furuya et al., 2014) |
| Cranial | |||||
| Cranial | DBS-Gpi | 64 | 17 | U | (Andrews et al., 2010*) |
| Bletharospasm | TMS | 31 | 12 | C | (Kranz et al., 2010) |
| Axial | |||||
| Camptocormia | DBS-Gpi | 62 | 9 | U | (Andrews et al., 2010*; Capelle et al., 2011) |
| Secondary | |||||
| Tardive Dystonia | DBS-Gpi | 78 | 50 | C | (Mentzel et al., 2012) |
| Cerebral Palsy | DBS-Gpi | 24 | 22 | U | (Andrews et al., 2010*) |
| Other Secondary | DBS-Gpi | 38 | 29 | U | (Andrews et al., 2010*) |
| Other Secondary | TMS | 20 | 3 | U | (Lefaucheur et al., 2004) |
| Combined | |||||
| Parkinson’s Disease | DBS-Gpi | 93 | 16 | C | (Loher et al., 2002; Volkmann et al., 1998) |
| Parkinson’s Disease | DBS-STN | 75 | 30 | C | (Detante et al., 2004; Krack et al., 1999) |
| Myoclonus Dystonia | DBS-Gpi | 60 | 30 | U | (Rughani and Lozano, 2013*) |
| PKAN | DBS-Gpi | 66 | 12 | U | (Andrews et al., 2010*) |
| Lubag (X-linked Dys-PD) | DBS-Gpi | 78 | 2 | U | (Andrews et al., 2010*) |
| Rapid Onset Dys-PD | DBS-Gpi | 13 | 2 | U | (Andrews et al., 2010*) |
| Lesch-Nyan | DBS-Gpi | 44 | 1 | U | (Andrews et al., 2010*) |
| Dystonia Deafness | DBS-Gpi | 75 | 1 | U | (Andrews et al., 2010*) |
| GM1 Gangliosides | DBS-Gpi | 20 | 1 | U | (Andrews et al., 2010*) |
| Wilsons | DBS-Gpi | 14 | 1 | U | (Sidiropoulos et al., 2013) |
Indicates meta-analyses that incorporate numerous individual studies, please refer to these articles for additional references.
References for Table 1 (can be placed in supplementary material as needed):
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