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Brain Advance Access originally published online on September 28, 2007
Brain 2007 130(11):2879-2886; doi:10.1093/brain/awm229
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© The Author (2007). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The Canadian multicentre study of deep brain stimulation for cervical dystonia

Zelma H. T. Kiss1, Kristina Doig-Beyaert1, Michael Eliasziw1,2, Joseph Tsui4, Angela Haffenden1,3, Oksana Suchowersky1 on behalf of the Functional and Stereotactic Section of the Canadian Neurosurgical Society and the Canadian Movement Disorders Group

1Department of Clinical Neuroscience, 2Department of Community Health Sciences, University of Calgary, 3Department of Psychology, Calgary Health Region, Calgary and 4Department of Medicine,University of British Columbia, Vancouver, Canada

Correspondence to: Dr Zelma H. T. Kiss, Room 182A, Heritage Medical Research Building, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1 E-mail: zkiss{at}ucalgary.ca

Deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) is an effective treatment for generalized dystonia. Its role in the management of other types of dystonia is uncertain. Therefore we performed a prospective, single-blind, multicentre study assessing the efficacy and safety of bilateral GPi-DBS in 10 patients with severe, chronic, medication-resistant cervical dystonia. Two blinded neurologists assessed patients before surgery and at 6 and 12 months post-operatively using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). The primary outcome measure was the severity subscore (range 0–30, higher scores indicating greater impairment). Secondary outcomes included disability (0 to 30), pain (0 to 40) subscores and total scores of the TWSTRS, Short Form-36 and Beck depression inventory. Swallowing and neuropsychological assessment were also performed at baseline and 12 months. One-way repeated measures analysis of variance was used to analyse the data.

The TWSTRS severity score improved from a mean (SD) of 14.7 (4.2) before surgery to 8.4 (4.4) at 12 months post-operatively (P = 0.003). The disability and pain scores improved from 14.9 (3.8) and 26.6 (3.6) before surgery, to 5.4 (7.0) and 9.2 (13.1) at 12 months, respectively (both P < 0.001). General health and physical functioning as well as depression scores improved significantly. Complications were mild and reversible in four patients. Some changes in neuropsychological tests were observed, although these did not impact daily life or employment. Our results support the efficacy and safety of GPi-DBS for the treatment of patients with severe and prolonged cervical dystonia who have failed medical management.

Key Words: dystonia; torticollis; deep brain stimulation; clinical trial; globus pallidus; high-frequency stimulation

Abbreviations: BDI, Beck depression inventory; DBS, deep brain stimulation; MRI, magnetic resonance imaging

Received May 4, 2007. Revised August 9, 2007. Accepted August 24, 2007.


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