Chronic Bilateral Electrostimulation of a Medial Segment of the Pale Globe in Local and Generalized Forms of Dystonia: Preliminary Results

Shabalov V., Tomskiy ., Dekopov ., Isagulyan E.

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

The research goal was to estimate results of electrostimulation of the pale globe medial segment (ES GPI) in generalized and local forms of deforming muscular dystonia.

Material and Methods. Stereotaxic implantation of the KINETRA (Medtronic) system for neurostimulation was performed in 17 cases (10 males, 7 females). It was implanted into the GPI on both sides. The mean age and disease duration were 31.4±12.7 and 8.4±6.2 years respectively. A generalized form was present in 11 cases (idiopathic - 7, secondary - 4). A local form, manifesting itself as torticollis, was observed in 6 patients (idiopathic - 4, secondary - 2). Inefficacy of pharmacotherapy and treatment with botulotoxin was an indication for operation. The results were estimated on the basis of the Global Outcome Scale (GOS), developed in the Texas Methodic Hospital and used for estimation of outcomes of dystonia surgery (a score of 1-5). Catamnesis varied from 3 up to 42 months.

Results. ES GPI decreased severity of motor symptoms to this or that extent in all the cases. The results were as follows: minimum reduction of motor disorders without functional improvement - 2 (the score of 1); moderate reduction of motor disorders with minimum functional improvement or without it - 2 (the score of 2); moderate reduction of motor disorders with functional improvement - 5 (the score of 3); considerable reduction of motor disorders with marked functional improvement - 8 (the score of 4). The best results were watched in cases with idiopathic dystonia. Dynamics of motor disorders was characterized by gradual clinical improvement against a background of ES. A state stabilization took place 6-9 months after operation.

Conclusion. Treatment of local and generalized forms of dystonia with applying chronic bilateral ES GPI is effective. It should be carried out in case of inefficacy of pharmacotherapy and neuromuscular blocks.