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Objective: To test if deep brain stimulation (DBS) treatment of dystonia was similar in patients before and after implantation of rechargeable internal pulse generators (IPGs)., Materials and Methods: The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) severity and disability scores were compared in patients before DBS insertion, 24 months after DBS insertion with a nonrechargeable IPG, and after implantation of a rechargeable IPG., Results: No significant differences were observed between dystonia control in patients before and after implantation of a rechargeable IPG., Conclusions: Rechargeable IPGs should be the IPGs of choice for dystonic patients receiving DBS as IPGs offer similar treatment efficacy to nonrechargeable IPGs with advantages in terms of costs and reductions in reimplantation frequency., (© 2013 International Neuromodulation Society.)

Objectives: Pallidal stimulation and pallidotomy are known to improve the symptoms of Parkinson's disease (PD). However, it is not known which modality produces greater benefit in patients who have already undergone unilateral pallidotomy. It is also suggested that the original pallidal surgery provides a greater benefit than subsequent pallidal surgery. The aim of this study was to analyze which modality produced greater PD symptom improvement in patients with a prior pallidotomy and whether the chronological order of the pallidal surgery influenced the size of the improvement., Methods: Five patients who had undergone a prior unilateral pallidotomy for PD were studied. Because of ongoing Parkinsonian symptoms, all patients subsequently underwent contralateral pallidal surgery, either a further pallidotomy or pallidal stimulation. All surgeries were performed by a single functional neurosurgeon and the patients prospectively assessed and scored at routine follow-ups. Paired-sample t-tests were used to detect differences in outcomes after first and second surgeries., Results: Two patients underwent pallidal stimulation and three underwent a second pallidotomy. Mean follow-up was 13.5 months and 12.3 months, respectively. Greater percentage improvements in the majority of scores were found after pallidal stimulation compared with a second pallidotomy, namely Unified Parkinson's Disease Rating Scale (UPDRS) II off (25.22% vs. -3.27%), UPDRS III off (36.15% vs. 5.21%), rigidity (58.34% vs. 11.54%), tremor (5.56% vs. -30.48%), bradykinesia (48.55% vs. -2.23%), gait composite (16.52% vs. -51.79%), dyskinesia duration (83.33% vs. 66.67%), dyskinesia disability (100% vs. 66.67%), speech (10% vs. -50%), and the proportion of the day spent in the "off" state (50% vs. 25%). Comparing outcomes after the first surgery to those after the second surgery, statistical differences were found in dyskinesia duration improvement and ipsilateral dyskinesia improvement after the second surgery (p < 0.004 and p = 0.021, respectively)., Conclusions: Pallidal stimulation produced greater symptom improvement than a second pallidotomy and subsequent surgery did not produce inferior results to the original pallidal surgery., (© 2010 International Neuromodulation Society.)

Objectives.  This is a prospective study to determine the outcomes of subthalamic nucleus (STN) vs. globus pallidus internus (GPi) deep brain stimulation (DBS) at our institution. Materials and Methods.  We studied a total of 39 patients - 29 with STN and 10 with GPi DBS over a period of up to 6 years. Mean ages in the two groups were similar (59 and 60 years, respectively) and disease duration prior to implantation was similar (9.6 and 11.7 years, respectively). Unified Parkinson Disease Rating Scale (UPDRS) was recorded preoperatively and at follow-up (at least at 6-month intervals). Medications also were recorded, and each patient's levodopa equivalent units (LEU) were calculated. Results were analyzed using a paired Student's t-test. Results.  LEU reduced significantly (p < 0.05) in the STN group (5.7 to 3.7) but not the GPi group. Both targets significantly improved part 3 and part 4 scores of the UPDRS but GPi DBS did not improve part 2 scores (activities of daily living). STN DBS had much better outcome on the motor "off" scores of the UPDRS, whereas GPi only improved tremor. A comparison of the "earliest 10" and "most recent 10" STN patients showed a significant improvement in outcome in the most recent cases. Conclusions.  In our group, STN was more effective for alleviating the symptoms of Parkinson disease, even in older patients with significant dyskinesias. Better patient selection and greater experience have led to more improvement in the more recent patients.

Objectives.  To perform a preliminary cost-utility and cost-benefit of deep brain stimulation (DBS) in the treatment of dystonia, Materials and Methods.  We conducted a prospective study of 26 patients undergoing DBS for the treatment of dystonia. We performed a cost-utility analysis using the Euroquol (EQ-5D) questionnaire. A cost-benefit analysis used the willingness-to-pay principle and costs of treatment were calculated retrospectively in order to calculate the cost-benefit. Results.  We found that the EQ-5D score improved from 29 to 76.2 points after surgery, an incremental utility of 0.47. There was an overall gain of 0.94 quality-adjusted life-years (QALY) with a cost of £33,980 per QALY. Conclusions.  DBS for dystonia, while an expensive treatment, compares favorably to therapies that are commonly used for other conditions.