Long-term Outcomes with Rescue Target Deep Brain Stimulation in Patients with Dystonia

Congratulations to Drs. Abigail HatcherPamela ZeilmanEdward OforiDavid VaillancourtKelly FooteMichael S. Okun and Aparna Wagle Shukla for their publication of “Long-term Outcomes with Rescue Target Deep Brain Stimulation in Patients with Dystonia” in the April supplement of Neurology.


Objective: Determine the long-term outcomes of rescue target deep brain stimulation (DBS) surgery in dystonia.

Background: Globus pallidus internus (GPi) and subthalamic nucleus (STN) are effective DBS targets for treatment of medication refractory dystonia, however the range of clinical improvements can be large. We offer a rescue target option to select patients exhibiting suboptimal DBS dystonia outcomes.

Design/Methods: We retrospectively identified among 102 dystonia DBS patients 8 cases of rescue target DBS who were followed for 3+ years following a rescue procedure. We tracked the Unified Dystonia Rating Scale (UDRS) scores for these patients before, after the initial DBS, and after the rescue DBS surgery. These cases were matched with 8 dystonia DBS patients without rescue leads based on disease duration, age, dystonia phenotype, initial DBS target, length of follow-up and pre-DBS UDRS scores.

Results: The rescue DBS cohort included 3 cervical and 5 generalized dystonia patients (mean age 53.2 ± 17.6 years; mean disease duration 16.8 ± 7.0 years). At a mean duration of 3.8 ± 2.4 years after initial bilateral GPi DBS, 7 patients received rescue lead STN DBS (5 bilateral, 2 unilateral); 1 patient received bilateral STN then bilateral GPi DBS. In the DBS cohort without rescue leads, UDRS scores improved by 48% (p = 0.03) at 3.8 ± 2.4 years with no further significant improvement at the last follow-up. In the cohort with rescue leads, UDRS scores initially only improved by 25% (p = 0.08) at 3.8 ± 2.4 years; rescue lead placement provided an additional 22.9% improvement. There was a total improvement of 47% (p = 0.01) at 3+ years after rescue DBS (9.5 ± 3.1 years after initial DBS).

Conclusions: Rescue target DBS can potentially be an effective treatment with sustained long-term benefits in this cohort. This procedure should be considered earlier for patients with suboptimal initial DBS outcomes.