Deep Brain Stimulation for Dystonia: Patient Selection, Surgical Technique, and Programming

Deep brain stimulation (DBS) at the internal globus pallidus (GPi) is currently approved for the treatment of primary generalized and segmental dystonia. Younger age at surgery, shorter disease duration, and absence of fixed skeletal deformities correlate with a better response to stimulation. Patients with cervical dystonia may also improve. As a group, patients with secondary dystonias respond less well to DBS than do patients with primary dystonia; however, patients with dystonia secondary to anoxic brain injury who have grossly intact basal ganglia anatomy, and patients with tardive dystonia may represent secondary dystonia sub-types for whom pallidal DBS is a viable option. In this submission we review the selection of dystonia patients for DBS surgery and provide details of our approach to surgery and device programming.