Nucleus ventralis oralis anterior a potential target in deep brain stimulation for post anoxic dystonia?

Deep brain stimulation (DBS) effectiveness in secondary dystonia is still debated. Different targets have been utilized, thalamic (Vim), zona incerta, sub thalamic nucleus (STN), and globus pallidus internus (GPi) with generally disappointing clinical results. Structural lesions of the GPi, the target of choice in Dystonia, are found in some cases of secondary dystonia and prevent us from treating these patients with DBS implantation. We report the third published case of a patient with severe generalized post anoxic dystonia, associated with bilateral necrosis of the GPi, who showed significant improvement after DBS procedure in the thalamic Ventralis oralis anterior (Voa). The Ventral oralis anterior nucleus; pallidal receiving area in the thalamic nuclei could be an alternative target.