Clinical Effectiveness of DBS for Dystonia

There are several globally recognized tools used to monitor the severity of dystonia. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) is a 120-point rating scale used to test the severity of dystonia in 9 body regions. This scale takes into account the severity and frequency of the dystonic movements. A higher score means greater impairment. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) is another commonly used rating scale for cervical dystonia. This exam consists of three sections: Severity (range 0-30), Disability (range 0-30), and Pain (range 0-40). Similar to the BFMDRS, a higher score indicates greater impairment from the disease. Multiple studies have demonstrated a reduction in BFMDRS and TWSTERS scores following deep brain stimulation therapy.
Primary
Author
Study
Design
Sample
Size
Follow
Up
BFMDRS or
TWSTERS
Change in Mean Scores
BFMDRS or TWSTERS
% Improvement 
in BFMDRS and TWSTERS

Cersosimo

et al, 2009¹

Prospective

Case Series

9 6 mos.

BFMDRS

(Motor Scale)

• Baseline: 46.9 ± 24.3

• Post DBS: 24.1 ± 16.9

Not Reported

Houeto et

al, 2007²

Prospective,

Controlled,

Multicenter

22 1 mo.

BFMDRS

(Motor Scale)

• Baseline: 46.3 ± 21.1

• Post DBS*: 26.7 ± 14.9

Not Reported

Vidailhet et

al, 2005³

Prospective,

Controlled,

Multicenter

22 12 mos.

BFMDRS

(Motor Scale)

• Baseline: 46.3 ± 21.3

• Post DBS: 21 ± 14.1

51

Vidailhet at

al, 2007⁴

Prospective,

Controlled,

Multicenter

22 36 mos.

BFMDRS

(Motor Scale)

• Baseline: 46.3 ± 21.3

• Post DBS: 19.8 ± 17.4

58

Kiss et al,

2007⁵

Prospective,

Single-Blind,

Multicenter

10 12 mos.

TWSTERS

(Severity

Score)

• Baseline: 14.7 ± 4.2

• Post DBS: 8.4 ± 4.4

43

Kupsch et

al, 2006⁶

Prospective,

Controlled,

Multi-center

40 6 mos.

BFMDRS

(Motor Scale)

• Baseline: 36.4 ± 24.6

• Post DBS: 20.2 ± 18

46

Volkmann

et al, 2012⁷

Prospective,

Controlled,

Multi-center

40 5 yrs.

BFMDRS

(Motor Scale)

• Baseline: 43.4 ± 28.6

• Post DBS: 15.4 ± 16.3

60

Ostrem et

al, 2011⁸

Prospective

Pilot

9 12 mos.

TWSTERS

(Total Score)

• Baseline: 53.1 ± 2.57

• Post DBS: 19.6 ± 5.48

62.9

Vidailhet et

al, 2009⁹

Prospective 13 12 mos.

BFMDRS

(Motor Scale)

• Baseline: 44.23 ± 21.12

• Post DBS: 34.69 ± 21.87

24.4
*Post-surgery ventral stimulation score
  1. Cersosimo MG, Raina GB, Benarroch EE, Piedimonte F, Aleman GG, & Micheli FE. “Micro lesion effect of the globus pallidus internus and outcome with deep brain stimulation in patients with Parkinson disease and dystonia.” Mov Disord 2009. 24(10), 1488-1493.
  2. Houeto JL, Yelnik J, Bardinet E, Vercueil L, Krystkowiak P, Mesnage V, Vidailhet M. “Acute deep-brain stimulation of the internal and external globus pallidus in primary dystonia: functional mapping of the pallidum.” Arch Neurol. 2007. Sep;64(9):1281-6.
  3. Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Benabid AL, Cornu P, Pollak P. “Bilateral deep-brain stimulation of the globus pallidus in primary generalized dystonia.” N Engl J Med 2005., 352(5), 459-467.
  4. Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Lagrange C, Yelnik J, Pollak P. “Bilateral, pallidal, deep-brain stimulation in primary generalized dystonia: a prospective 3 year follow-up study.” Lancet Neurol 2007. 6(3), 223-229. 
  5. Kiss ZH, Doig-Beyaert K, Eliasziw M, Tsui J, Haffenden A, Suchowersky O. “The Canadian multicenter study of deep brain stimulation for cervical dystonia.” Brain 2007, 130(Pt 11), 2879-2886.
  6. Kupsch A, Benecke R, Müller J, Trottenber, T, Schneider GH, Poewe W, Volkmann J. “Pallidal Deep-Brain Stimulation in Primary Generalized or Segmental Dystonia.” New Engl J Med 2006, 355(19), 1978-1990.
  7. Volkmann J, Wolters A, Kupsch A, Muller J, Kuhn AA, Schneider GH, Benecke R. “ Pallidal deep brain stimulation in patients with primary generalised or segmental dystonia: 5-year follow-up of a randomized trial.” Lancet Neurol 2012. 11(12), 1029-1038.
  8. Ostrem JL, Racin, CA, Glass GA, Grace JK, Volz MM, Heath SL, Starr PA. “Subthalamic nucleus deep brain stimulation in primary cervical dystonia.” Neurol 2011. 76(10), 870-878.
  9. Vidailhet M, Yelnik J, Lagrange C, Fraix V, Grabli D, Thobois S, Pollak P. “Bilateral pallidal deep brain stimulation for the treatment of patients with dystonia-choreoathetosis cerebral palsy: a prospective pilot study.” Lancet Neurol 2009. 8(8), 709-717.
 
Results from different clinical investigations are not directly comparable. Information provided for educational purposes only.
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