Abstract Details

Title Breaking the Bend: Successful Anterocollis Treatment with Bilateral Globus Pallidus Internus Deep Brain Stimulation

Topic Movement Disorders

Presentation(s) P10 - Poster Session 10 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-009

Objective Report the effectiveness of bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) for management of anterocollis in patients with isolated dystonia.

Background Anterocollis is one of the most difficult forms of cervical dystonia (CD) to treat. Botulinum toxin therapy (BoNT) can be technically challenging and is accompanied by high rates of side effects including neck weakness and dysphagia. GPi DBS is an effective long-term treatment for patients with CD. However, outcomes in patients with anterocollis as the primary postural abnormality have been inconsistent and scarce.

Design/Methods We retrospectively reviewed clinical characteristics and outcomes of DBS therapy in patients with anterocollis as the primary feature of their dystonia at our large academic institution.

Results Four patients managed with GPi DBS for refractory symptoms with prominent anterocollis were identified (three females). Mean age at DBS implantation was 67 years. Mean follow-up was 4 years (range 2-9 years). All patients had isolated dystonia with moderate to severe anterocollis as primary feature prior to DBS, with mean total Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score of 45.8 (SD=8.5) and severity score of 21 (SD=3.2). Mean TWSTRS total score decreased to 6.5 points (SD=4.7), and severity score decreased to 5.5 points (SD=5) at the most recent follow-up evaluation. All patients had improvement in TWSTRS by the 12-month programming visit that exceeded the minimal clinically important change; this benefit was sustained for the duration of follow-up. All patients initially received BoNT for anterocollis prior to DBS; three stopped due to lack of efficacy and one stopped after DBS. Final effective DBS stimulation parameters were variable, but a common theme of high pulse width ranging from 110-180µs was noted.

Conclusions Bilateral GPi DBS therapy can be an effective option for patients with anterocollis in isolated dystonia. High pulse widths (110-180µs) may be beneficial for optimal symptom control.

Authors/Disclosures
Patricia Jokl Graese, MD PRESENTER	Dr. Graese has nothing to disclose.
Amanda Currie, MD (Vanderbilt)	Dr. Currie has nothing to disclose.
Aparna Wagle-Shukla, MD, FAAN (UF Fixel)	Dr. Wagle-Shukla has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Encora. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Supernus. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Tremor research group. The institution of Dr. Wagle-Shukla has received research support from NIH. Dr. Wagle-Shukla has received personal compensation in the range of $500-$4,999 for serving as a reviewer with NIH.
Adolfo Ramirez Zamora, MD (University of Louisville)	Dr. Ramirez Zamora has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevel therapeutics. Dr. Ramirez Zamora has received personal compensation in the range of $0-$499 for serving as a Consultant for NeuroPacs. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Boston Scientific. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Iota Inc. Dr. Ramirez Zamora has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Maplight. Dr. Ramirez Zamora has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. The institution of Dr. Ramirez Zamora has received research support from Parkinsons Foundation.

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