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01-05-2020 | Torticollis Spasticus | Original Communication

A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia

Authors: Takashi Tsuboi, Joshua K. Wong, Leonardo Almeida, Christopher W. Hess, Aparna Wagle Shukla, Kelly D. Foote, Michael S. Okun, Adolfo Ramirez-Zamora

Published in: Journal of Neurology | Issue 5/2020

Abstract

Objective

To analyze deep brain stimulation (DBS) outcomes in patients with cervical dystonia (CD), the relationships between motor and disability/pain outcomes, and the differences in outcomes between globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS, and to identify potential outcome predictors.

Methods

A systematic literature search identified individual patient data of CD patients who underwent DBS and whose outcomes were assessed with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Then, we performed a pooled meta-analysis on this cohort.

Results

A review of 39 papers yielded 208 patients with individual TWSTRS scores and demographic information. At a mean follow-up period of 23.3 months after either GPi or STN DBS, the TWSTRS total (58.8%), severity (53.9%), disability (61.3%), and pain (46.6%) scores significantly improved compared to baseline status (all p < 0.001). There were no significant outcome differences between short-term (< 23.3 months) and long-term (≥ 23.3 months). The TWSTRS outcomes after GPi and STN DBS were comparable, whereas these two targets showed different adverse effect profiles. The rates of responders to DBS according to the TWSTRS total and severity (defined as ≥ 25% improvement) were both 89%. Regression analyses demonstrated motor benefits associated with disability improvement more than pain relief (R² = 0.345 and 0.195, respectively). No clinically meaningful predictors for DBS outcomes were identified.

Conclusion

DBS improves motor symptoms, disability, and pain in CD patients and may provide sustained benefits over 2 years. GPi and STN appear to be equally effective targets with different adverse effect profiles.

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Title: A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia
Authors: Takashi Tsuboi
Joshua K. Wong
Leonardo Almeida
Christopher W. Hess
Aparna Wagle Shukla
Kelly D. Foote
Michael S. Okun
Adolfo Ramirez-Zamora
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keywords: Torticollis Spasticus
Dystonia
Deep Brain Stimulation
Published in: Journal of Neurology / Issue 5/2020
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-020-09703-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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