STN and GPi-Deep Brain Stimulation for Primary Cervical Dystonia

To evaluate the safety and efficiency of deep brain stimulation (DBS) in the treatment of primary cervical dystonia (CD) and to compare the difference between the STN (subthalamic nucleus)-DBS and GPi (Globus Pallidus internus)-DBS. Experimental study. Place and Duration of the Study: Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, from January 2012 to December 2021. This study analysed the effects of DBS on 34 patients with primary cervical dystonia (CD) based on the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). It included 15 STN-DBS and 19 GPi-DBS cases, with TWSTRS scores collected at baseline and the final follow-up. Stimulation parameters and adverse events were also recorded. The mean follow-up time was 42.77 ± 27.46 months. A significant improvement in TWSTRS total scores was observed in all patients (p <0.001), with no significant difference between STN-DBS and GPi-DBS groups (p = 0.481). The amplitude of stimulation in the GPi group was found to be higher than that in the STN group (p <0.001). Adverse events included one case of electrode breakage in the STN-DBS group, mild dyskinesias in 14 patients (twelve from the STN-DBS group and two from the GPi-DBS group), and other stimulation-related complications in four patients (one from the STN-DBS group and three from the GPi-DBS group). All stimulation-related complications were manageable with parameter adjustments. DBS can significantly improve the symptoms of primary CD patients, with no significant difference in outcomes between STN-DBS and GPi-DBS. It has a good long-term therapeutic effect and surgical safety. Cervical dystonia, Deep brain stimulation, Globus pallidus internus, Subthalamic nucleus.