ELIGIBILITY CRITERIA FOR DBS IN DYSTONIA

  • In general, surgical referral for all types of dystonia can be considered in patients who have failed trials with anticholinergic drugs, benzodiazepines, and levodopa in generalized/segmental dystonia, or had no benefit or failure with botulinum toxin injections in cranial and cervical dystonia.
  • There is currently no widely accepted consensus about which type of medication, which dose, or how many trials are needed before surgery.
  • In general, it is not mandatory to have tried all available medications.
  • Symptoms should be disabling enough to justify the surgical risk.
  • The Burke-Fahn-Marsden (BFMD) Dystonia Rating Scale and the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) are two validated and widely used scales used to measure dystonia disability and compare pre- and postoperatory outcomes.
  • During the preoperatory assessment, it is generally important to consider using quality of life (QoL) scales, as this is often the main reason for surgery.
  • Preoperatory investigations usually involve imaging, although there is no special technique requirement.
  • Usually, a brainMRI scan is required to support the diagnosis of idiopathic or secondary dystonia.
  • The presence of minor structural abnormalities in the basal ganglia in idiopathic dystonia is not a contraindication for DBS.
  • In cervical dystonia, recurrent involuntary neck movements can often exacerbate osteoarthritic cervical spondylosis, which may be an independent factor causing neck pain.
  • To assess the degree of arthritic spinal degeneration and any need for spinal surgery before or after DBS, a cervical spine MRI scan may be needed.
  • In addition,skeletal imaging might be useful to quantify spinal deformities that are common in children with dystonia secondary to GAG deletion in the TOR1A gene (DYT-1)-related disease.
  • Other evaluations that should be considered include a complete neuropsychology/psychiatric assessment before and after surgery.
  • This is especially important in selected patients with psychiatric comorbidities because of high psychiatric comorbidity in the dystonia population and a few suicides have been reported after GPi DBS.

I am a Movement Disorder neurologist interested in innovative medical education and use of technology in education and clinical care of my patients. My primary interest is in Parkinson Disease and am currently involved in online courses in Movement Disorders and Research with Parkinson Study Group in Neuro-protection. My hobby is biosensors and smartphone applications for diagnosis

Leave a reply:

Your email address will not be published.

Sliding Sidebar

About Me

About Me

I am a Movement Disorder neurologist interested in innovative medical education and use of technology in education and clinical care of my patients. My primary interest is in Parkinson Disease and am currently involved in online courses in Movement Disorders and Research with Parkinson Study Group in Neuro-protection. My hobby is biosensors and smartphone applications for diagnosis.

Subscribe to our newsletter
Sign up here to get the latest news, updates and special offers delivered directly to your inbox.
You can unsubscribe at any time