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The efficacy of deep brain stimulation in the subthalamic nucleus in isolated dystonia

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INTRODUCTION: DBS is a safe and effective therapy for patients with isolated (inherited or idiopathic) and medically refractory dystonia in both generalized and severe focal and segmental dystonia. Subthalamic nucleus DBS for dystonia publications has been limited to small series and case reports. Therefore, the objective of this systematic review was to provide clinical evidence of the efficacy of DBS in the STN in isolated dystonia. METHODS: For this article, we performed a comprehensive search in databases for articles published from 1987 to 2022. We included patients with primary dystonia, focal, segmental, or generalized, who underwent DBS placement in STN and had no prior brain lesioning or brain surgeries. Data collected included demographics, clinical features of dystonia, adverse events, stimulation parameters, and quality of life scales. RESULTS: The literature search resulting in the identification of 20 relevant articles corresponding to 14 distinct studies and reporting 114 cases. There were 75 women (65,7%) and 39 men. The mean age of onset was 37.2 ± 19.1 years (± SD) and the duration of dystonia was 9.1 ± 8.8 years (± SD). They were 40 focal dystonia, 44 segmental dystonia, and 30 generalized dystonia. The mean follow-up time was 12.8 months (range 3-33 months). The BFMDRS movements and TWSTRS scores were significantly lower in pos operatives values (p < 0.0001), with a mean decrease of 55.3% (CI 48.97-61.6). In total, 20 patients experience an improvement of more than 80% over the preoperative score. Subitem analysis revealed a 61.4% score for focal dystonia, 47.8% in segmental dystonia, and 57.5% in generalized dystonia. The BFMDRS disability scale scores had also improvement (p < 000.1), with mean reduction of 43.9% (p = 0.0057). The quality of life was assessed in only five studies using SF-36 scores. The patients’ quality of life was improved significantly (p < 0.0001) in every subitem of the scale. DISCUSSION: This meta-analysis represents the current data on DBS in STN in primary dystonia. Our findings support sustained improvement in motor function, measured by absolute and percentage changes in the BFMDRS and TWSTRS scores from baseline. We also observed an improved ability to perform activities of daily living and quality of life access through BFMDRS disability and SF-36 score.

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