A prospective blinded evaluation of deep brain stimulation for the treatment of secondary dystonia and primary torticollis syndromes

2008 ◽  
Vol 109 (3) ◽  
pp. 405-409 ◽  
Author(s):  
Theresa E. Pretto ◽  
Arif Dalvi ◽  
Un Jung Kang ◽  
Richard D. Penn
Keyword(s):  
Quality Of Life ◽  
Botulinum Toxin ◽  
Rating Scale ◽  
Spasmodic Torticollis ◽  
Global Rating Scale ◽  
Global Rating ◽  
Secondary Dystonia ◽  
Botulinum Toxin Injections ◽  
Deep Brain

Object The aim of this study was to provide an objective assessment of deep brain stimulation (DBS) for groups of patients with mixed secondary dystonia and primary torticollis syndromes by a blinded evaluation of 13 consecutive patients who underwent ineffective medical treatment and botulinum toxin injections. Methods Nine patients with secondary dystonia and 4 with cranial dystonia involving prominent spasmodic torticollis were selected for a DBS implant after they underwent unsuccessful medical treatment. Preoperative videos and neurological assessments were obtained and the DBS implant was inserted into the globus pallidus internus. Postoperatively, DBS parameters were adjusted to provide optimal benefit. Postoperative videotapes and quality of life scores were obtained. Blinded randomized evaluation of videotapes was performed by a neurologist specializing in movement disorders. Videos were scored using the Unified Dystonia Rating Scale, Toronto Western Spasmodic Torticollis Rating Scale, Burke-Fahn-Marsden Dystonia Rating Scale, or Abnormal Involuntary Movement Scale. Quality of life scoring was assessed using a standardized 7-point Global Rating Scale. Results All 13 patients completed preoperative videotaping, medical assessment, and surgery. Optimal DBS programming was completed in 6.5 visits over 5.9 months. Seven patients reported marked improvement, 3 reported moderate improvement, 2 reported slight improvement or no change, and 1 was lost to follow-up. Examiner scores on the Global Rating Scale reflected patient self-reported scores. Conclusions Global subjective gains and notable objective improvement were observed in 11 of 13 patients. Although the benefits were variable and not fully predictable, they were of sufficient magnitude to justify offering the procedure when medications and botulinum toxin injections have failed.

Subthalamic nucleus deep brain stimulation for severe idiopathic dystonia: impact on severity, neuropsychological status, and quality of life

2007 ◽  
Vol 107 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Galit Kleiner-Fisman ◽  
Grace S. Lin Liang ◽  
Paul J. Moberg ◽  
Anthony C. Ruocco ◽  
Howard I. Hurtig ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Short Form ◽  
Spasmodic Torticollis ◽  
Sf 36 ◽  
Deep Brain

Object Medically refractory dystonia has recently been treated using deep brain stimulation (DBS) targeting the globus pallidus internus (GPI). Outcomes have varied depending on the features of the dystonia. There has been limited literature regarding outcomes for refractory dystonia following DBS of the subthalamic nucleus (STN). Methods Four patients with medically refractory, predominantly cervical dystonia underwent STN DBS. Intraoperative assessments with the patients in a state of general anesthesia were performed to determine the extent of fixed deformities that might predict outcome. Patients were rated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) preoperatively and 3 and 12 months following surgery by a rater blinded to the study. Mean changes and standard errors of the mean in scores were calculated for each subscore of the two scales. Scores were also analyzed using analysis of variance and probability values were generated. Neuropsychological assessments and quality of life ratings using the 36-Item Short Form Health Survey (SF-36) were evaluated longitudinally. Results Significant improvements were seen in motor (p = 0.04), disability (p = 0.02), and total TWSTRS scores (p = 0.03). Better outcomes were seen in those patients who did not have fixed deformities. There was marked improvement in the mental component score of the SF-36. Neuropsychological function was not definitively impacted as a result of the surgery. Conclusions Deep brain stimulation of the STN is a novel target for dystonia and may be an alternative to GPI DBS. Further studies need to be performed to confirm these conclusions and to determine optimal candidates and stimulation parameters.

scholarly journals The physical, social and emotional aspects are the most affected in the quality of life of the patients with cervical dystonia

2014 ◽  
Vol 72 (6) ◽  
pp. 405-410 ◽  
Author(s):  
Roberta Weber Werle ◽  
Sibele Yoko Mattozo Takeda ◽  
Marise Bueno Zonta ◽  
Ana Tereza Bittencourt Guimarães ◽  
Hélio Afonso Ghizoni Teive
Keyword(s):  
Quality Of Life ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Motor Impairment ◽  
Residual Effect ◽  
Spasmodic Torticollis ◽  
Social And Emotional ◽  
Emotional Aspects ◽  
Craniocervical Dystonia

Objective : Describe the functional, clinical and quality of life (QoL) profiles in patients with cervical dystonia (CD) with residual effect or without effect of botulinum toxin (BTX), as well as verify the existence of correlation between the level of motor impairment, pain and QoL. Method : Seventy patients were assessed through the Craniocervical dystonia questionnaire-24 (CDQ-24) and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Results : The greater the disability, pain and severity of dystonia, the worse the QoL (p<0.0001). Greater severity relates to greater disability (p<0.0001). Pain was present in 84% of the sample, being source of disability in 41%. The most frequent complaints were: difficulty in keeping up with professional and personal demands (74.3%), feeling uneasy in public (72.9%), hindered by pain (68.6%), depressed, annoyed or bitter (47.1%), lonely or isolated (32.9%). Conclusion : The physical, social and emotional aspects are the most affected in the QoL of these patients.

scholarly journals Quality of life in individuals with cervical dystonia before botulinum toxin injection in a Brazilian tertiary care hospital

2011 ◽  
Vol 69 (6) ◽  
pp. 900-904 ◽  
Author(s):  
Mariana Ribeiro Queiroz ◽  
Hsin Fen Chien ◽  
Egberto Reis Barbosa
Keyword(s):  
Quality Of Life ◽  
Botulinum Toxin ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Short Form ◽  
Tertiary Care ◽  
Residual Effect ◽  
Care Hospital ◽  
Sf 36

OBJECTIVE: The purpose of this study was to evaluate quality of life (QoL) in a Brazilian population of individuals with cervical dystonia (CD) without effect of botulinum toxin (BTx) or with only residual effect of BTx, and identify possible physical and social aspects that affect their QoL. METHOD: Sixty five out of sixty seven consecutive patients with CD were assessed with two instruments: Short-form Health Survey with 36 questions (SF-36) and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). RESULTS: Severity of CD (TWSTRS) correlated moderately with two SF-36 subscale: role-physical (r= -0.42) and body pain (r= -0.43). Women also scored worse in two subscale of SF-36: vitality (p<0.05) and mental-health (p<0.005). CONCLUSION: Severity of CD and gender (female) were the main factors related to a worse QoL perception. These findings may help health professionals to predict which characteristics could lead to worse QoL, and therefore, better target their interventions to lessen the burden caused by CD.

scholarly journals Jaw-Opening Dystonia: Quality of Life after Botulinum Toxin Injections

2011 ◽  
Vol 90 (2) ◽  
pp. E9-E12 ◽  
Author(s):  
Steven J. Charous ◽  
Cynthia L. Cornelia ◽  
Wenqing Fan
Keyword(s):  
Quality Of Life ◽  
Botulinum Toxin ◽  
Jaw Opening ◽  
Botulinum Toxin Injections

scholarly journals Ventral tegmental area deep brain stimulation for chronic cluster headache: Effects on cognition, mood, pain report behaviour and quality of life

Cephalalgia ◽  
2019 ◽  
Vol 39 (9) ◽  
pp. 1099-1110 ◽  
Author(s):  
Davide Cappon ◽  
Agata Ryterska ◽  
Susie Lagrata ◽  
Sarah Miller ◽  
Harith Akram ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Ventral Tegmental Area ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Chronic Cluster Headache ◽  
Headache Frequency ◽  
Deep Brain

Background Deep brain stimulation in the ventral tegmental area (VTA-DBS) has provided remarkable therapeutic benefits in decreasing headache frequency and severity in patients with medically refractory chronic cluster headache (CH). However, to date the effects of VTA-DBS on cognition, mood and quality of life have not been examined in detail. Methods The aim of the present study was to do so in a case series of 18 consecutive patients with cluster headache who underwent implantation of deep brain stimulation electrodes in the ventral tegmental area. The patients were evaluated preoperatively and after a mean of 14 months of VTA-DBS on tests of global cognition (Mini Mental State Examination), intelligence (Wechsler Abbreviated Scale of Intelligence), verbal memory (California Verbal Learning Test-II), executive function (Delis–Kaplan Executive Function System), and attention (Paced Auditory Serial Addition Test). Depression (Beck Depression Inventory and Hospital Anxiety and Depression Rating Scale-D), anxiety (Hospital Anxiety and Depression Rating Scale-A), apathy (Starkstein Apathy Scale), and hopelessness (Beck Hopelessness Scale) were also assessed. Subjective pain experience (McGill Pain Questionnaire), behaviour (Pain Behaviour Checklist) and quality of life (Short Form-36) were also evaluated at the same time points. Results VTA-DBS resulted in significant improvement of headache frequency (from a mean of five to two attacks daily, p < .001) and severity (from mean Verbal Rating Scale [VRS] of 10 to 7, p < .001) which was associated with significant reduction of anxiety (from mean HADS-A of 11.94 to 8.00, p < .001) and help-seeking behaviours (from mean PBC of 4.00 to 2.61, p < .001). VTA-DBS did not produce any significant change to any tests of cognitive function and any other outcome measures (BDI, HADS-D, SAS, BHS, McGill Pain Questionnaire, Short Form-36). Conclusion We confirm the efficacy of VTA-DBS in the treatment of medically refractory chronic cluster headache. The reduction of headache frequency and severity was associated with a significant reduction of anxiety. Furthermore, the result suggests that VTA-DBS for chronic cluster headache improves pain-related help-seeking behaviours and does not produce any change in cognition.

Unilateral pallidotomy as a potential rescue therapy for cervical dystonia after unsatisfactory selective peripheral denervation

2020 ◽  
Vol 33 (5) ◽  
pp. 658-666
Author(s):  
Yijie Lai ◽  
Peng Huang ◽  
Chencheng Zhang ◽  
Liangyun Hu ◽  
Zhengdao Deng ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Rescue Therapy ◽  
Common Adverse Event ◽  
Spasmodic Torticollis ◽  
Limb Weakness ◽  
Unilateral Pallidotomy

OBJECTIVESelective peripheral denervation (SPD) is a widely accepted surgery for medically refractory cervical dystonia (CD), but when SPD has failed, the available approaches are limited. The authors investigated the results from a cohort of CD patients treated with unilateral pallidotomy after unsatisfactory SPD.METHODSThe authors retrospectively analyzed patients with primary CD who underwent unilateral pallidotomy after SPD between April 2007 and August 2019. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was used to evaluate symptom severity before surgery, 7 days postsurgery, 3 months postsurgery, and at the last follow-up. TWSTRS subscores for disability and pain and the 24-item Craniocervical Dystonia Questionnaire (CDQ-24) were used to assess quality of life.RESULTSAt a mean final follow-up of 5 years, TWSTRS severity subscores and total scores were significantly improved (n = 12, mean improvement 57.3% and 62.3%, respectively, p = 0.0022 and p = 0.0022), and 8 of 12 patients (66.7%) were characterized as responders (improvement ≥ 25%). Patients with rotation symptoms before pallidotomy showed greater improvement in TWSTRS severity subscores than those who did not (p = 0.049). The most common adverse event was mild upper-limb weakness (n = 3). Patients’ quality of life was also improved.CONCLUSIONSUnilateral pallidotomy seems to offer an effective and safe option for patients with CD who have otherwise experienced limited benefits from SPD.

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