Deep brain stimulation dramatically improves symptoms for patients with severe cervical dystonia

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Implanting electrodes into a pea-sized part of the brain can dramatically improve life for people with severe cervical dystonia, according to the results of a pilot study led by Jill Ostrem and Philip Starr at the University of California, San Francisco, USA.

Nowadays, people with cervical dystonia can be treated with medications or injections of botulinum toxin, which interrupt signals from the brain that cause these spasms. However, those treatments do not provide adequate relief for all patients.

 

Over the last decade, doctors at the University of California and elsewhere have turned to deep brain stimulation to help people with debilitating dystonia; also used to treat Parkinson’s disease and the neurological disorder essential tremor.

 

Traditionally doctors have treated cervical dystonia with deep brain stimulation by targeting the globus pallidus internus. Reporting this week in the journal Neurology, the University of California team described the results of the first detailed clinical study looking at deep brain stimulation targeting a completely different part of the brain: the “subthalamic nucleus.”

 

“This target is very widely used for Parkinson’s disease but not widely used for dystonia,” said Starr, professor of neurological surgery, University of California, and senior author of the paper.

 

The study, led by Ostrem, associate professor of neurology, University of California, involved nine patients followed for one year after surgery. “Patients in this study had failed medical treatments, but with the surgery, they were able to improve their movements and quality of life—as well as overcome some of their disability and pain,” said Ostrem.

 

Video analysis and standard measures of dystonia showed the surgeries lowered pain, reduced spasms and improved the overall quality of life without causing serious side effects.

 

“Medications and botulinum toxin injections still remain the first line of treatment,” Ostrem said, “but for those who are really still suffering, we think deep brain stimulation using this new stimulation location offers another choice for them.”

 

The team is now planning to enrol more patients into a longer study following outcomes for three years post-surgery.