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. 2008 Apr;5(2):320–330. doi: 10.1016/j.nurt.2008.01.002

Treatment of dystonia with deep brain stimulation

Jill L Ostrem 1,2,✉, Philip A Starr 2,3
PMCID: PMC5084173  PMID: 18394573

Summary

Pallidal deep brain stimulation (DBS) is an established treatment option for medically refractive dystonia. The mechanism by which globus pallidus pars interna (GPi) DBS improves dystonia is still unclear. Primary generalized dystonia usually responds well to this therapy, as recently confirmed in two well-designed, double-blind, controlled trials; however, predictors of outcome within this population are not well known. The role of GPi DBS in idiopathic cervical dystonia resistant to treatment with botulinum toxin, in tardive dystonia, and in some types of secondary dystonia are emerging as populations of patients who may also benefit, but outcomes are not well documented. Serious complications from this therapy are rare. Future research will likely continue to address the most appropriate programming settings for various populations of dystonia, the mechanism by which DBS affects dystonia, and the possibility of alternative brain targets that might have less associated side effects or greater efficacy than the GPi.

Key Words: Dystonia, deep brain stimulation, surgical outcomes, implantable device, neuromodulation, globus pallidus

References

  • 1.Fahn S, Bressman SB, Marsden CD. Classification of dystonia. Adv Neurol. 1998;78:1–10. [PubMed] [Google Scholar]
  • 2.Ozelius LJ, Hewett JW, Page CE, Bressman SB, Kramer PL, Shalish C, de Leon D, Brin MF, Raymond D, Corey DP, Fahn S, Risch NJ, Buckler AJ, Gusella JF, Breakefield XO. The early-onset torsion dystonia gene (DYT1) encodes an ATP-binding protein. Nat Genet. 1997;17:40–48. doi: 10.1038/ng0997-40. [DOI] [PubMed] [Google Scholar]
  • 3.Marsden CD, Obeso JA, Zarranz JJ, Lang AE. The anatomical basis of symptomatic hemidystonia. Brain. 1985;108:463–483. doi: 10.1093/brain/108.2.463. [DOI] [PubMed] [Google Scholar]
  • 4.Asanuma K, Ma Y, Okulski J, et al. Decreased striatal D2 receptor binding in non-manifesting carriers of the DYT1 dystonia mutation. Neurology. 2005;64:347–349. doi: 10.1212/01.WNL.0000149764.34953.BF. [DOI] [PubMed] [Google Scholar]
  • 5.Eidelberg D, Moeller JR, Antonini A, et al. Functional brain networks in DYT1 dystonia. Ann Neurol. 1998;44:303–312. doi: 10.1002/ana.410440304. [DOI] [PubMed] [Google Scholar]
  • 6.Starr PA, Rau GM, Davis V, et al. Spontaneous pallidal neuronal activity in human dystonia: comparison with Parkinson’s disease and normal macaque. J Neurophysiol. 2005;93:3165–3176. doi: 10.1152/jn.00971.2004. [DOI] [PubMed] [Google Scholar]
  • 7.Silberstein P, Kühn AA, Kupsch A, et al. Patterning of globus pallidus local field potentials differs between Parkinson’s disease and dystonia. Brain. 2003;126:2597–2608. doi: 10.1093/brain/awg267. [DOI] [PubMed] [Google Scholar]
  • 8.Vitek JL, Chockkan V, Zhang JY, et al. Neuronal activity in the basal ganglia in patients with generalized dystonia and hemiballismus. Ann Neurol. 1999;46:22–35. doi: 10.1002/1531-8249(199907)46:1<22::AID-ANA6>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  • 9.Merello M, Cerquetti D, Cammarota A, et al. Neuronal globus pallidus activity in patients with generalised dystonia. Mov Disord. 2004;19:548–554. doi: 10.1002/mds.10700. [DOI] [PubMed] [Google Scholar]
  • 10.Sanghera MK, Grossman RG, Kalhorn CG, Hamilton WJ, Ondo WG, Jankovic J. Basal ganglia neuronal discharge in primary and secondary dystonia in patients undergoing pallidotomy. Neurosurgery. 2003;52:1358–1373. doi: 10.1227/01.NEU.0000064805.91249.F5. [DOI] [PubMed] [Google Scholar]
  • 11.Tang JK, Moro E, Mahant N, et al. Neuronal firing rates and patterns in the globus pallidus intemus of patients with cervical dystonia differ from those with Parkinson’s disease. J Neurophysiol. 2007;98:720–729. doi: 10.1152/jn.01107.2006. [DOI] [PubMed] [Google Scholar]
  • 12.LeDoux MS, Lorden JF. Abnormal spontaneous and harmaline-stimulated Purkinje cell activity in the awake genetically dystonic rat. Exp Brain Res. 2002;145:457–467. doi: 10.1007/s00221-002-1127-4. [DOI] [PubMed] [Google Scholar]
  • 13.Burke RE, Fahn S. Double-blind evaluation of trihexyphenidyl in dystonia. Adv Neurol. 1983;37:189–192. [PubMed] [Google Scholar]
  • 14.Burke RE, Fahn S, Marsden CD. Torsion dystonia: a double-blind, prospective trial of high-dosage trihexyphenidyl. Neurology. 1986;36:160–164. doi: 10.1212/wnl.36.2.160. [DOI] [PubMed] [Google Scholar]
  • 15.Nutt JG, Hammerstad JP, deGarmo P, Carter J. Cranial dystonia: double-blind crossover study of anticholinergics. Neurology. 1984;34:215–217. doi: 10.1212/wnl.34.2.215. [DOI] [PubMed] [Google Scholar]
  • 16.The National Institutes of Health Consensus Development Conference on Clinical Use of Botulinum Toxin Consensus Panel Botulinum toxin. Consens Statement. 1990;8(8):1–20. [PubMed] [Google Scholar]
  • 17.Albanese A, Barnes MP, Bhatia KP, et al. A systematic review on the diagnosis and treatment of primary (idiopathic) dystonia and dystonia plus syndromes: report of an EFNS/MDS-ES Task Force. Eur J Neurol. 2006;13:433–444. doi: 10.1111/j.1468-1331.2006.01537.x. [DOI] [PubMed] [Google Scholar]
  • 18.Jankovic J. Botulinum toxin: clinical implication of antigenicity and immunoresistance. In: Brin MF, Jankovic J, Hallett M, editors. Scientific and therapeutic aspects of botulinum toxin. Philadelphia: Lippincott Williams & Wilkins; 2002. pp. 409–415. [Google Scholar]
  • 19.Bertrand CM. Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observations in 260 cases. Surg Neurol. 1993;40:96–103. doi: 10.1016/0090-3019(93)90118-K. [DOI] [PubMed] [Google Scholar]
  • 20.Ford B, Greene P, Louis ED, et al. Use of intrathecal baclofen in the treatment of patients with dystonia. Arch Neurol. 1996;53:1241–1246. doi: 10.1001/archneur.1996.00550120049016. [DOI] [PubMed] [Google Scholar]
  • 21.Walker RH, Danisi FO, Swope DM, Goodman RR, Germano IM, Brin MF. Intrathecal baclofen for dystonia: benefits and complications during six years of experience. Mov Disord. 2000;15:1242–1247. doi: 10.1002/1531-8257(200011)15:6<1242::AID-MDS1028>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  • 22.Albright AL, Barry MJ, Shafton DH, Ferson SS. Intrathecal baclofen for generalized dystonia. Dev Med Child Neurol. 2001;43:652–657. doi: 10.1017/S0012162201001190. [DOI] [PubMed] [Google Scholar]
  • 23.Cooper IS. 20-year follow-up study of the neurosurgical treatment of dystonia musculorum deformans. Adv Neurol. 1976;14:423–452. [PubMed] [Google Scholar]
  • 24.Andrew J, Fowler CJ, Harrison MJG. Stereotaxic thalamotomy in 55 cases of dystonia. Brain. 1983;106:981–1000. doi: 10.1093/brain/106.4.981. [DOI] [PubMed] [Google Scholar]
  • 25.Starr PA, Turner RS, Rau G, et al. Microelectrode-guided implantation of deep brain stimulators into the globus pallidus intemus for dystonia: techniques, electrode locations, and outcomes. J Neurosurg. 2006;104:488–501. doi: 10.3171/jns.2006.104.4.488. [DOI] [PubMed] [Google Scholar]
  • 26.Comella CL, Leurgans S, Wuu J, Stebbins GT, Chmura T, Dystonia Study Group Rating scales for dystonia: a multicenter assessment. Mov Disord. 2003;18:303–312. doi: 10.1002/mds.10377. [DOI] [PubMed] [Google Scholar]
  • 27.Burke RE, Fahn S, Marsden CD, Bressman SB, Moskowitz C, Friedman J. Validity and reliability of a rating scale for the primary torsion dystonias. Neurology. 1985;35:73–77. doi: 10.1212/wnl.35.1.73. [DOI] [PubMed] [Google Scholar]
  • 28.Comella CL, Stebbins GT, Goetz CG, Chmura TA, Bressman SB, Lang AE. Teaching tape for the motor section of the Toronto Western Spasmodic Torticollis Scale. Mov Disord. 1997;12:570–575. doi: 10.1002/mds.870120414. [DOI] [PubMed] [Google Scholar]
  • 29.Vayssière N, Hemm S, Zanca M, et al. Magnetic resonance imaging stereotactic target localization for deep brain stimulation in dystonia children. J Neurosurg. 2000;93:784–790. doi: 10.3171/jns.2000.93.5.0784. [DOI] [PubMed] [Google Scholar]
  • 30.Bereznai B, Steude U, Seelos K, Bötzel K. Chronic high frequency globus pallidus intemus stimulation in different types of dystonia: a clinical, video, and MRI report of six patients presenting with segmental, cervical, and generalized dystonia. Mov Disord. 2002;17:138–144. doi: 10.1002/mds.1250. [DOI] [PubMed] [Google Scholar]
  • 31.Vayssière N, van der Gaag N, Cif L, et al. Deep brain stimulation for dystonia confirming a somatotopic organization in the globus pallidus intemus. J Neurosurg. 2004;101:181–188. doi: 10.3171/jns.2004.101.2.0181. [DOI] [PubMed] [Google Scholar]
  • 32.Vidailhet M, Vercueil L, Houeto JL, et al. Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia. Lancet Neurol. 2005;352:459–467. doi: 10.1056/NEJMoa042187. [DOI] [PubMed] [Google Scholar]
  • 33.Ostrem JL, Marks WJ, Volz MM, Heath SL, Starr PA. Pallidal deep brain stimulation in patients with cranial—cervical dystonia (Meige syndrome) Mov Disord. 2007;22:1885–1891. doi: 10.1002/mds.21580. [DOI] [PubMed] [Google Scholar]
  • 34.Kiss ZH, Doig-Beyaert K, Eliasziw M, Tsui J, Haffenden A, Suchowersky O, Functional and Stereotactic Section of the Canadian Neurosurgical Society. Canadian Movement Disorders Group The Canadian multicentre study of deep brain stimulation for cervical dystonia. Brain. 2007;130:2879–2886. doi: 10.1093/brain/awm229. [DOI] [PubMed] [Google Scholar]
  • 35.Tisch S, Zrinzo L, Limousin P, et al. Effect of electrode contact location on clinical efficacy of pallidal deep brain stimulation in primary generalised dystonia. J Neurol Neurosurg Psychiatry. 2007;78:1314–1319. doi: 10.1136/jnnp.2006.109694. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Hung SW, Hamani C, Lozano AM, et al. Long-term outcome of bilateral pallidal deep brain stimulation for primary cervical dystonia. Neurology. 2007;68:457–459. doi: 10.1212/01.wnl.0000252932.71306.89. [DOI] [PubMed] [Google Scholar]
  • 37.Vercueil L, Houeto JL, Krystkowiak P, et al. Effects of pulse width variations in pallidal stimulation for primary generalized dystonia. J Neurol. 2007;254:1533–1537. doi: 10.1007/s00415-007-0578-8. [DOI] [PubMed] [Google Scholar]
  • 38.Alterman RL, Miravite J, Weisz D, Shils JL, Bressman SB, Tagliati M. Sixty hertz pallidal deep brain stimulation for primary torsion dystonia. Neurology. 2007;69:681–688. doi: 10.1212/01.wnl.0000267430.95106.ff. [DOI] [PubMed] [Google Scholar]
  • 39.Goto S, Mita S, Ushio Y. Bilateral pallidal stimulation for cervical dystonia: an optimal paradigm from our experiences. Stereotact Funct Neurosurg. 2002;79:221–227. doi: 10.1159/000070835. [DOI] [PubMed] [Google Scholar]
  • 40.Vidailhet M, Vercueil L, Houeto JL, et al. Bilateral, pallidal, deep-brain stimulation in primary generalised dystonia: a prospective 3 year follow-up study. Lancet Neurol. 2007;6:223–229. doi: 10.1016/S1474-4422(07)70035-2. [DOI] [PubMed] [Google Scholar]
  • 41.Kupsch A, Benecke R, Müller J, et al. Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med. 2006;355:1978–1990. doi: 10.1056/NEJMoa063618. [DOI] [PubMed] [Google Scholar]
  • 42.Diamond A, Shahed J, Azher S, Dat-Vuong K, Jankovic J. Globus pallidus deep brain stimulation in dystonia. Mov Disord. 2006;21:692–695. doi: 10.1002/mds.20767. [DOI] [PubMed] [Google Scholar]
  • 43.Bittar RG, Yianni J, Wang S, et al. Deep brain stimulation for generalised dystonia and spasmodic torticollis. J Clin Neurosci. 2005;12:12–16. doi: 10.1016/j.jocn.2004.03.025. [DOI] [PubMed] [Google Scholar]
  • 44.Cif L, El Fertit H, Vayssière N, et al. Treatment of dystonic syndromes by chronic electrical stimulation of the internal globus pallidus. J Neurosurg Sci. 2003;47:52–55. [PubMed] [Google Scholar]
  • 45.Yianni J, Bain PG, Gregory RP, et al. Post-operative progress of dystonia patients following globus pallidus intemus deep brain stimulation. Eur J Neurol. 2003;10:239–247. doi: 10.1046/j.1468-1331.2003.00592.x. [DOI] [PubMed] [Google Scholar]
  • 46.Vesper J, Klostermann F, Funk T, Stockhammer F, Brock M. Deep brain stimulation of the globus pallidus internus (GPi) for torsion dystonia: a report of two cases. Acta Neurochir Suppl. 2002;79:83–88. doi: 10.1007/978-3-7091-6105-0_19. [DOI] [PubMed] [Google Scholar]
  • 47.Tronnier VM, Fogel W. Pallidal stimulation for generalized dystonia: report of three cases. J Neurosurg. 2000;92:453–456. doi: 10.3171/jns.2000.92.3.0453. [DOI] [PubMed] [Google Scholar]
  • 48.Vercueil L, Pollak P, Fraix V, et al. Deep brain stimulation in the treatment of severe dystonia. J Neurol. 2001;248:695–700. doi: 10.1007/s004150170116. [DOI] [PubMed] [Google Scholar]
  • 49.Coubes P, Cif L, El Fertit H, et al. Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results. J Neurosurg. 2004;101:189–194. doi: 10.3171/jns.2004.101.2.0189. [DOI] [PubMed] [Google Scholar]
  • 50.Eltahawy HA, Saint-Cyr J, Giladi N, Lang AE, Lozano AM. Primary dystonia is more responsive than secondary dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery. 2004;54:613–619. doi: 10.1227/01.NEU.0000108643.94730.21. [DOI] [PubMed] [Google Scholar]
  • 51.Yianni J, Bain P, Giladi N, et al. Globus pallidus internus deep brain stimulation for dystonic conditions: a prospective audit. Mov Disord. 2003;18:436–442. doi: 10.1002/mds.10380. [DOI] [PubMed] [Google Scholar]
  • 52.Krauss JK, Loher TJ, Weigel R, Capelle HH, Weber S, Burgunder JM. Chronic stimulation of the globus pallidus internus for treatment of non-DYT1 generalized dystonia and choreoathetosis: 2-year follow-up. J Neurosurg. 2003;98:785–792. doi: 10.3171/jns.2003.98.4.0785. [DOI] [PubMed] [Google Scholar]
  • 53.Krause M, Fogel W, Kloss M, Rasche D, Volkmann J, Tronnier V. Pallidal stimulation for dystonia. Neurosurgery. 2004;55:1361–1368. doi: 10.1227/01.NEU.0000143331.86101.5E. [DOI] [PubMed] [Google Scholar]
  • 54.Katayama Y, Fukaya C, Kobayashi K, Oshima H, Yamamoto T. Chronic stimulation of the globus pallidus intemus for control of primary generalized dystonia. Acta Neurochir Suppl. 2003;87:125–128. doi: 10.1007/978-3-7091-6081-7_26. [DOI] [PubMed] [Google Scholar]
  • 55.Zorzi G, Marras C, Nardocci N, et al. Stimulation of the globus pallidus intemus for childhood-onset dystonia. Mov Disord. 2005;20:1194–1200. doi: 10.1002/mds.20510. [DOI] [PubMed] [Google Scholar]
  • 56.Kumar R, Dagher A, Hutchison WD, Lang AE, Lozano AM. Globus pallidus deep brain stimulation for generalized dystonia: clinical and PET investigation. Neurology. 1999;53:871–874. doi: 10.1212/wnl.53.4.871. [DOI] [PubMed] [Google Scholar]
  • 57.Eltahawy HA, Saint-Cyr J, Giladi N, Lang AE, Lozano AM. Primary dystonia is more responsive than secondary dystonia to pallidal interventions: outcome after pallidotomy or pallidal deep brain stimulation. Neurosurgery. 2004;54:613–619. doi: 10.1227/01.NEU.0000108643.94730.21. [DOI] [PubMed] [Google Scholar]
  • 58.Işlekel S, Zileli M, Zileli B. Unilateral pallidal stimulation in cervical dystonia. Stereotact Funct Neurosurg. 1999;72:248–252. doi: 10.1159/000029736. [DOI] [PubMed] [Google Scholar]
  • 59.Krauss JK, Pohle T, Weber S, Ozdoba C, Burgunder J. Bilateral stimulation of the globus pallidus internus for treatment of cervical dystonia. Lancet. 1999;354:837–838. doi: 10.1016/S0140-6736(99)80022-1. [DOI] [PubMed] [Google Scholar]
  • 60.Kulisevsky J, Lleó A, Gironell A, Molet J, Pascual-Sedano B, Parés P. Bilateral pallidal stimulation for cervical dystonia: dissociated pain and motor improvement. Neurology. 2000;55:1754–1755. doi: 10.1212/wnl.55.11.1754. [DOI] [PubMed] [Google Scholar]
  • 61.Krauss JK, Loher TJ, Pohle T, et al. Pallidal deep brain stimulation in patients with cervical dystonia and severe cervical dyskinesias with cervical myelopathy. J Neurol Neurosurg Psychiatry. 2002;72:249–256. doi: 10.1136/jnnp.72.2.249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 62.Kiss ZH, Doig K, Eliasziw M, Ranawaya R, Suchowersky O. The Canadian multicenter trial of pallidal deep brain stimulation for cervical dystonia: preliminary results in three patients. Neurosurg Focus. 2004;17(1):E5–E5. doi: 10.3171/foc.2004.17.1.5. [DOI] [PubMed] [Google Scholar]
  • 63.Goto S, Yamada K. Long term continuous bilateral pallidal stimulation produces stimulation independent relief of cervical dystonia. J Neurol Neurosurg Psychiatry. 2004;75:1506–1507. doi: 10.1136/jnnp.2003.031104. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 64.Hebb MO, Chiasson P, Lang AE, Brownstone RM, Mendez I. Sustained relief of dystonia following cessation of deep brain stimulation. Mov Disord. 2007;22:1958–1962. doi: 10.1002/mds.21616. [DOI] [PubMed] [Google Scholar]
  • 65.Muta D, Goto S, Nishikawa S, et al. Bilateral pallidal stimulation for idiopathic segmental axial dystonia advanced from Meige syndrome refractory to bilateral thalamotomy. Mov Disord. 2001;16:774–777. doi: 10.1002/mds.1122. [DOI] [PubMed] [Google Scholar]
  • 66.Houser M, Waltz T. Meige syndrome and pallidal deep brain stimulation. Mov Disord. 2005;20:1203–1205. doi: 10.1002/mds.20522. [DOI] [PubMed] [Google Scholar]
  • 67.Foote KD, Sanchez JC, Okun MS. Staged deep brain stimulation for refractory craniofacial dystonia with blepharospasm: case report and physiology. Neurosurgery. 2005;56:E415–E415. doi: 10.1227/01.NEU.0000147978.67424.42. [DOI] [PubMed] [Google Scholar]
  • 68.Opherk C, Gruber C, Steude U, Dichgans M, Bötzel K. Successful bilateral pallidal stimulation for Meige syndrome and spasmodic torticollis. Neurology. 2006;66:E14–E14. doi: 10.1212/01.wnl.0000190257.55434.ab. [DOI] [PubMed] [Google Scholar]
  • 69.Castelnau P, Cif L, Valente EM, et al. Pallidal stimulation improves pantothenate kinase-associated neurodegeneration. Ann Neurol. 2005;57:738–741. doi: 10.1002/ana.20457. [DOI] [PubMed] [Google Scholar]
  • 70.Stair PA, Marks WJ, Lindsey N, Byrd D, Rau G, Turner R. Pallidal deep brain stimulation for dystonia: technical approach and magnetic resonance imaging verified electrode locations. Neurosurgery. 2003;53:494–494. [Google Scholar]
  • 71.Umemura A, Jaggi JL, Dolinskas CA, Stern MB, Baituch GH. Pallidal deep brain stimulation for longstanding severe generalized dystonia in Hallervorden-Spatz syndrome: case report. J Neurosurg. 2004;100:706–709. doi: 10.3171/jns.2004.100.4.0706. [DOI] [PubMed] [Google Scholar]
  • 72.Trottenberg T, Paul G, Meissner W, Maier-Hauff K, Taschner C, Kupsch A. Pallidal and thalamic neurostimulation in severe tardive dystonia. J Neurol Neurosurg Psychiatry. 2001;70:557–559. doi: 10.1136/jnnp.70.4.557. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 73.Chouinard G, Margolese H. Manual for the Extrapyramidal Symptom Rating Scale (ESRS) Schizophr Res. 2005;76:247–265. doi: 10.1016/j.schres.2005.02.013. [DOI] [PubMed] [Google Scholar]
  • 74.Damier P, Thobois S, Witjas T, et al. Bilateral deep brain stimulation of the globus pallidus to treat tardive dyskinesia. Arch Gen Psychiatry. 2007;64:170–176. doi: 10.1001/archpsyc.64.2.170. [DOI] [PubMed] [Google Scholar]
  • 75.Magariños-Ascone CM, Regidor I, Martínez-Castrillo JC, Gómez-Galán M, Figueiras-Méndez R. Pallidal stimulation relieves myoclonus-dystonia syndrome. J Neurol Neurosurg Psychiatry. 2005;76:989–991. doi: 10.1136/jnnp.2004.039248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 76.Cif L, Valente EM, Hemm S, et al. Deep brain stimulation in myoclonus-dystonia syndrome. Mov Disord. 2004;19:724–727. doi: 10.1002/mds.20030. [DOI] [PubMed] [Google Scholar]
  • 77.Evidente VG, Lyons MK, Wheeler M, et al. First case of X-linked dystonia-parkinsonism (“Lubag”) to demonstrate a response to bilateral pallidal stimulation. Mov Disord. 2007;22:1790–1793. doi: 10.1002/mds.21420. [DOI] [PubMed] [Google Scholar]
  • 78.Deutschlander A, Asmus F, Gasser T, Steude U, Bötzel K. Sporadic rapid-onset dystonia-parkinsonism syndrome: failure of bilateral pallidal stimulation. Mov Disord. 2005;20:254–257. doi: 10.1002/mds.20296. [DOI] [PubMed] [Google Scholar]
  • 79.Loher TJ, Hasdemir MG, Burgunder JM, Krauss JK. Long-term follow-up study of chronic globus pallidus intemus stimulation for posttraumatic hemidystonia. J Neurosurg. 2000;92:457–460. doi: 10.3171/jns.2000.92.3.0457. [DOI] [PubMed] [Google Scholar]
  • 80.Chang JW, Choi JY, Lee BW, Kang UJ, Chung SS. Unilateral globus pallidus intemus stimulation improves delayed onset post-traumatic cervical dystonia with an ipsilateral focal basal ganglia lesion. J Neurol Neurosurg Psychiatry. 2002;73:588–590. doi: 10.1136/jnnp.73.5.588. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 81.Detante O, Vercueil L, Thobois S, et al. Globus pallidus internus stimulation in primary generalized dystonia: a H215O PET study. Brain. 2004;127:1899–1908. doi: 10.1093/brain/awh213. [DOI] [PubMed] [Google Scholar]
  • 82.Silay K, Larson P, Starr P. Deep brain stimulator infections: incidence and management in a large series. Neurosurgery 2008 (in press). [DOI] [PubMed]
  • 83.Yianni J, Nandi D, Shad A, Bain P, Gregory R, Aziz T. Increased risk of lead fracture and migration in dystonia compared with other movement disorders following deep brain stimulation. J Clin Neurosci. 2004;11:243–245. doi: 10.1016/j.jocn.2003.10.003. [DOI] [PubMed] [Google Scholar]
  • 84.Ghika J, Villemure JG, Fankhauser H, Favre J, Assal G, Ghika-Schmid F. Efficiency and safety of bilateral contemporaneous pallidal stimulation (deep brain stimulation) in levodopa-responsive patients with Parkinson’s disease with severe motor fluctuations: a 2-year follow-up review. J Neurosurg. 1998;89:713–718. doi: 10.3171/jns.1998.89.5.0713. [DOI] [PubMed] [Google Scholar]
  • 85.Sellai F, Hirsch E, Barth P, Blond S, Marescaux C. A case of symptomatic hemidystonia improved by ventroposterolateral thalamic electrostimulation. Mov Disord. 1993;8:515–518. doi: 10.1002/mds.870080418. [DOI] [PubMed] [Google Scholar]
  • 86.Loher TJ, Krauss JK, Burgunder JM, Taub E, Siegfried J. Chronic thalamic stimulation for treatment of dystonic paroxysmal nonkinesigenic dyskinesia. Neurology. 2001;56:268–270. doi: 10.1212/wnl.56.2.268. [DOI] [PubMed] [Google Scholar]
  • 87.Nikkhah G, Prokop T, Hellwig B, Lücking CH, Ostertag CB. Deep brain stimulation of the nucleus ventralis intermedius for Holmes (rubral) tremor and associated dystonia caused by upper brainstem lesions: report of two cases. J Neurosurg. 2004;100:1079–1083. doi: 10.3171/jns.2004.100.6.1079. [DOI] [PubMed] [Google Scholar]
  • 88.Fukaya C, Katayama Y, Kano T, et al. Thalamic deep brain stimulation for writer’s cramp. J Neurosurg. 2007;107:977–982. doi: 10.3171/JNS-07/11/0977. [DOI] [PubMed] [Google Scholar]
  • 89.Taira T, Hori T. Stereotactic ventrooralis thalamotomy for task-specific focal hand dystonia (writer’s cramp) Stereotact Funct Neurosurg. 2003;80:88–91. doi: 10.1159/000075165. [DOI] [PubMed] [Google Scholar]
  • 90.Kleiner-Fisman G, Liang GS, Moberg PJ, et al. Subthalamic nucleus deep brain stimulation for severe idiopathic dystonia: impact on severity, neuropsychological status, and quality of life. J Neurosurg. 2007;107:29–36. doi: 10.3171/JNS-07/07/0029. [DOI] [PubMed] [Google Scholar]
  • 91.Chou KL, Hurtig HI, Jaggi JL, Baltuch GH. Bilateral subthalamic nucleus deep brain stimulation in a patient with cervical dystonia and essential tremor. Mov Disord. 2005;20:377–380. doi: 10.1002/mds.20341. [DOI] [PubMed] [Google Scholar]
  • 92.Pastor-Gómez J, Hernando-Requejo V, Luengo Dos Santos A, Pedrosa-Sánchez M, Sola RG. Treatment of a case of generalized dystonia using subthalamic stimulation [In Spanish] Rev Neurol. 2003;37:529–531. [PubMed] [Google Scholar]
  • 93.Detante O, Vercueil L, Krack P, Chabardes S, Benabid AL, Pollak P. Off-period dystonia in Parkinson’s disease but not generalized dystonia is improved by high-frequency stimulation of the subthalamic nucleus. Adv Neurol. 2004;94:309–314. [PubMed] [Google Scholar]
  • 94.Sun B, Chen S, Zhan S, Le W, Krahl S. Subthalamic nucleus stimulation for primary dystonia and tardive dystonia. Acta Neurochir Suppl. 2007;97:207–214. doi: 10.1007/978-3-211-33081-4_23. [DOI] [PubMed] [Google Scholar]
  • 95.Novak KE, Nenonene EK, Bernstein LP, Vergenz S, Cozzens JW, Rezak M. Successful bilateral subthalamic nucleus stimulation for segmental dystonia after unilateral pallidotomy. Stereotact Funct Neurosurg. 2007;86:80–86. doi: 10.1159/000112428. [DOI] [PubMed] [Google Scholar]
  • 96.Kupsch A, Klaffke S, Kühn AA, et al. The effects of frequency in pallidal deep brain stimulation for primary dystonia. J Neurol. 2003;250:1201–1205. doi: 10.1007/s00415-003-0179-0. [DOI] [PubMed] [Google Scholar]
  • 97.Grips E, Blahak C, Capelle HH, et al. Patterns of reoccurrence of segmental dystonia after discontinuation of deep brain stimulation. J Neurol Neurosurg Psychiatry. 2007;78:318–320. doi: 10.1136/jnnp.2006.089409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 98.Zhang JG, Zhang K, Wang ZC, Ge M, Ma Y. Deep brain stimulation in the treatment of secondary dystonia. Chin Med J. 2006;119:2069–2074. [PubMed] [Google Scholar]

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