Outcomes after Deep Brain Stimulation for Generalized Dystonia

Abstract

Abstract Background Deep Brain Stimulation (DBS) is an already established treatment option for refractory dystonia. Its main targets are currently the globus pallidus internus (GPi) and the subthalamic nucleus (STN) with similar motor and disability outcomes, 50 to 70% in isolated generalized/segmental inherited/idiopathic dystonia. This systematic review and meta- analysis aimed to assess the efficacy outcomes of DBS use in patients with generalized dystonia. Methods This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the searched strategy was developed using the Mesh Database to find the similar keywords to the main keywords in our study. We searched PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar for eligible articles to be included in our study using the following search strategy: (Brain Stimulations OR Deep Brain Stimulations OR Brain Stimulation OR Deep Brain Stimulation OR Electrical Stimulation of the Brain) AND (movement disorders OR dystonia syndromes OR dystonia). Results A total of 25 articles were included in our meta-analysis. The pooled analysis of 25 studies showed the improvement in the BFMDRS-movement score after deep brain stimulation as evident by the decrease in the pos-DBS values with an overall mean difference of -25.96 (95%CI: -29.24 - -22.69, p < 0.00001) with moderate heterogeneity (I2=51%, p = 0.002). Regarding BFMDRS-disability score, it was statistically significant reduced after deep brain stimulation compared to pre-operative values with an overall mean difference of -5.69 (95%CI: -7.04 - -4.35, p < 0.00001) and moderate heterogeneity (I2=50%, p = 0.02). Conclusion Our study demonstrated the deep brain stimulation's excellent efficacy across various parameters. This included mobility and disability on the BFMDRS, while the use of DBS is linked to improved post-operative results when compared to pre-operative values. Furthermore, according to the SF-36, which measures both mental and physical performance, DBS has demonstrated a high efficacy on quality of life. Furthermore, DBS was linked to a considerable decline in depressed symptoms, as demonstrated by the BDI score, which dropped dramatically in individuals with generalized dystonia following DBS application.