Abstract and Introduction
Deep-brain stimulation of the internal globus pallidus is a therapeutic option for dystonia. However, the available data are heterogeneous, ranging from single case reports to a few controlled studies. The outcomes are also largely heterogeneous, depending mostly on the etiology of the dystonia. Except for some well-established good indications, such as primary generalized dystonia and tardive dyskinesia, the efficacy of globus pallidus stimulation remains debated for several forms of dystonia. In addition, many issues are still unsolved, such as the best target of stimulation and the interest of simultaneously combining multiple targets of stimulation or not. Finally the efficacy of new strategies of treatment, such as cortical stimulation, remains to be determined. The aim of this review is to cover these different aspects and give an overview of the current indications and future orientations.
Dystonia represents a very heterogeneous group of entities depending on their clinical presentation and etiology. Recently, a consensus update has been proposed for a better classification of dystonia. These authors classified dystonia according to two axes: the clinical characteristics and the etiology. Deep-brain stimulation (DBS) has been proposed as an interesting therapeutic option for dystonia since the late 1990s.[2,3] Since then, a large number of studies have been published demonstrating variable results, depending mainly on the etiology of the dystonia, but also on the clinical presentation, stimulation parameters or the stimulation target. Despite this variability, some lessons can be learnt from the available literature and 'good' and 'bad' indications of DBS in dystonia can be distinguished. The aim of this article is to give an overview of the current state-of-the-art of DBS in dystonia, including other forms of neuromodulation and future perspectives.
Future Neurology. 2014;9(1):77-87. © 2014 Future Medicine Ltd.