Long-term Follow-up Of Bilateral Subthalamic Deep Brain Stimulation For Refractory Tardive Dystonia

Background: No effective treatment for tardive dystonia(TD)has been well established.Deep brain stimulation(DBS)has shown a prominent advantage in ameliorating motor manifestations in primary dystonia,which may also be an effective approach for TD.Objectives: This study aimed to illuminate the long-term efficacy and safety of subthalamic nucleus(STN)-DBS in treating TD.Methods: Ten patients with refractory TD underwent STN-DBS therapy and were assessed by the Burke-Fahn-Marsden dystonia rating scale(BFMDRS),Abnormal Involuntary Movement Scale(AIMS),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA),and the Short Form(36)Health Survey(SF-36)at four time points: pre-operation,1 week,6 months,and at a final long-term postsurgical follow-up timepoint.Results: The mean follow-up time was 65.6±30.4 months(range,12–105 months);we found improvement in BFMDRS motor and disability scores of 55.9±28.3% and 62.6±32.0%,respectively.AIMS scores improved by 53.3±26.7%.We observed further amelioration at the second follow-up visit,showing improvement in BFMDRS motor and disability scores of 87.3±17.0% and 84.3%±22.9%,respectively.AIMS scores improved by 88.4±16.1%.At the last follow-up,this benefit was sustained and plateaued,as reflected by an 88.3±21.6% reduction in BFMDRS motor scores,85.0%±33.7% change in BFMDRS disability scores,and 93.6±12.4% reduction in AIMS scores.Quality of life improved significantly after long-term follow-up,and HAMA and HAMD scores displayed a significant reduction and persisted after the first follow-up.Conclusion: STN-DBS may be an effective and acceptable procedure for TD,leading to persistent and significant improvement in both movement and psychiatric symptoms.