Introduction: Dystonia is a syndrome of sustained involuntary muscle contraction, frequently causing twisting or repetitive movements or abnormal postures.
Secondary dystonia comprise the syndromes that have dystonic symptoms due to brain injury associated with neonatal encephalopathy syndromes, trauma, vascular injury, infections, demyelinations, or other hereditary disorders associated with neurodegeneration.
Patients can be categorized as having focal, segmental, or generalized symptoms.
Some modalities of treatments are more effective in certain types of dystonias. For example, pharmacological treatment in the form of medications is usually the first course of action in the early childhood-onset dystonia.
Aim of the study:
This study aims to compare the functional outcomes of different available neuroablative and neuromodulating techniques directed to treat secondary dystonia.
Methods: This is a prospective comparative study addressing the functional outcomes of different available neurosurgical techniques for treatment of secondary dystonia.
Fifty patients suffering from intractable handicapping dystonia which may be of focal, segmental or generalized distribution, despite optimal oral medication and physical therapy were included in this study.
Patients were divided into two major groups:
Group A: who were subjected to neuroablative techniques and included 30 patients: 20 patients had combined anterior and posterior lumbar rhizotomies (CAPR), and 10 patients had bilateral pallidotomies.
Group B: included 20 patients who were subjected to neuromodulation techniques: 19 patients had deep brain stimulation (DBS) and 6 had intra- thecal Baclofen (ITB) pump infusion.
All patients were assessed clinically by a multidisciplinary team including a neurosurgeon, a neurologist, a physiotherapist, and an orthopedic surgeon.
Results: Fifty patients were enrolled in this study, 28 males and 22 females. The mean age was 21.3 years. All patients were shown up in all follow up evaluation visits up to 12 months post-operatively, and were evaluated by the multidisciplinary team for outcome measurements.
Both neuroablative and neuromodulation techniques had shown improvement regarding muscle tone and involuntary movements, with no significant statistical difference in both groups.
Conclusions: Both neuroablative and neuromodulating techniques have the beneficial impact on secondary dystonias especially with stationary neurological pathologies with no significant statistical difference between both techniques.
Patient Care: Neuroablative surgeries have a similar impact to neuromodulation in treatment of secondary dystonias
Learning Objectives: Neuroablative surgical techniques have a similar effect to neuromodulation techniques in treatment of secondary dystonias