Which patients with Dystonia benefit from Deep Brain Stimulation?- a meta-regression of individual patient outcomes
Résumé
There is substantial variability in the responsiveness of dystonia patients to deep brain stimulation (DBS), presumably due to the multiple causes of dystonia. This article presents the results of an analysis of the combined published results of individual patient outcomes following DBS for all types of dystonia. From 157 papers reporting clinical outcomes of DBS for dystonia, individual quantitative data were available for 466 patients with all forms of dystonia. The sub-classification of these patients included 344 with primary forms of dystonia, 10 with myoclonus dystonia, 19 with heredo-degenerative dystonias and 93 patients that had DBS for secondary dystonia. Patients with primary forms of dystonia, myoclonus dystonia, subtypes of heredo-degenerative dystonia and tardive dystonia have a greater than 50% mean improvement in dystonia severity following DBS. Among patients with primary generalised dystonia, multiple regression analysis showed that a shorter duration of symptoms (p=0.008), a lower baseline severity score (p=0.024) and DYT-1 positive status (p=0.002) were all independently associated with a significantly higher percentage improvement from surgery. Patients with other forms of heredodegenerative and secondary dystonia have variable responses making prediction of response in future patients difficult. The degree of dystonia response that justifies DBS is a highly subjective issue. Emphasis should be placed on both safety of surgical technique and an in depth evaluation of patients' own perception of their life before and after DBS by using validated quality of life measures, in addition to existing use of objective severity scales.
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