Authors: Joo Pyung Kim Won Seok Chang Jin Woo Chang
Publish Date: 2011/09/11
Volume: 153, Issue: 12, Pages: 2319-2328
Abstract
Between March 2003 and January 2009 four patients underwent bilateral globus pallidus internus GPi DBS and six patients underwent bilateral GPi DBS plus unilateral thalamotomy for treatment of cerebral palsy CP Among the patients with secondary dystonia without CP five were also treated by DBS We classified patients with generalized secondary dystonia with cerebral palsy into group I and patients with focal dystonia without CP into group II Clinical outcome assessments were based on BurkeFahnMarsden Dystonia Rating Scale movement and disability scores Heathrelated quality of life was assessed with a 36item shortform general health survey questionnaire preoperatively and at the last followupThe movement and disability scores of group IA had improved by 320 P = 0285 and 143 P = 0593 respectively at the last followup compared with baseline The movement and disability scores of group IB had improved by 315 and 018 at the last followup compared with baseline respectively In comparison with patients in group IA patients in group IB showed a significant improvement in movement scores for the contralateral arm P = 0042 Group II patients showed a marked improvement in movement and disability scores of 777 P = 0039 and 800 P = 0041 respectivelyWe demonstrated that DBS plus unilateral ventralis oralis thalamotomy for CP patients with fixed states in the upper extremities is useful not only to treat secondary dystonic movement but also to improve quality of life In group II patients with posttraumatic dystonia and tardive dyskinesia we achieved excellent clinical outcomes using a stereotactic procedureIn this interesting paper the authors report their experience in a small population of adult patients with secondary dystonia with or without CP their surgical approach consisted of GPi/DBS and GPi/DBS plus Vo thalamotomy In group I CPdystonia there were ten patients IA four patients underwent bilateral DBS/GPi and IB six patients underwent GPi/DBS plus Vo thalamotomy Group II consisted of secondary dystonia without CPIn group I patients treated with GPi/DBS plus Vo thalamotomy experienced an improvement of the movement and disability scores of 315 and 018 and patients with GPi/DBS had improvement of 32 and 143 In group II all patient were treated with DBS/GPi there was a significant improvement in movement and disability scores of 77 and 80 respectively The authors should be congratulated for their relatively novel and aggressive approach to secondary dystonia a condition traditionally very difficult to treat and for their good surgical results and lack of complications
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