Deep Brain Stimulation in Dystonia: When and Where? Survey Summer 2008

Dystonic disorders comprise a heterogeneous group of movement disorders, reflecting different disease entities. They are accompanied by significant loss of quality of life and may lead to significant motor disablement including wheel chair dependency. Medical therapeutic options are limited, especially in generalised dystonia. The introduction of deep brain stimulation for the treatment of movement disorders (e.g., essential tremor and advanced Parkinson's disease) has opened new therapeutic avenues also for dystonic disorders. Thus, regions deeply located in the brain may be functionally influenced by the reversible application of electrical charge via stereotactically implanted electrodes (deep brain stimulation) without structurally lesioning brain tissue. In 2 multicentre, blinded studies, an improvement of dystonic symptoms in patients with primary generalised or segmental dystonia of approximately 50% following deep brain stimulation of the internal pallidum has been documented, which led to approval of deep brain stimulation in the EU for the treatment of primary generalised and segmental dystonias. The following review summarises the results and the perspectives of deep brain stimulation in dystonia, also with respect to emerging paediatric indications.