Sustained Relief after Discontinuation of DBS for Dystonia: Implications for the Possible Role of Synaptic Plasticity and Cortical Reorganization^[*]

Introduction

Dystonia is a movement disorder that is notoriously difficult to treat. Oral medications and botulinium toxin denervation have been the mainstay of treatment for many years, but both have been proven to be only moderately effective.[1] [2] In recent years, however, deep brain stimulation (DBS) has emerged as a reliable, safe, reversible and adjustable treatment for many forms of medically refractory dystonia. The globus pallidus internus (GPi) seems to predominate as the target of choice, although other targets, such as the subthalamic nucleus (STN) have been reported to yield comparable results.[2] Nonetheless, a convincing explanation of the beneficial effects of DBS in dystonia has remained elusive; the mechanism by which DBS interacts with the brain structures in alleviating dystonia is not only poorly understood, but also paradoxical at times. Our poor understanding of the mechanisms of action of DBS is corroborated by cases such as the one reported herein.

^* This article was originally published online in Central European Neurosurgery on May 31, 2011 (DOI:10.1055/s-0030-1267247)

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