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Pallidotomy and deep brain stimulation (DBS) of the globus pallidus internus (GPi) has been investigated for medically intractable dystonia.1,2⇓ Attention has mainly focused on motor function; little is known about modification of dystonia-associated pain, which contributes considerably to functional disability.3 We report two patients with idiopathic cervical dystonia (ICD) with only mild motor improvement but marked amelioration of pain symptoms following bilateral DBS of the posteroventral GPi.
Patient 1.
A 35-year-old woman presented with a 20-year medically intractable segmental ICD and severe pain in her neck and shoulders. At age 34 she experienced reactive depression and attempted suicide. Results of blood analysis—including copper, ceruloplasmin, and acanthocytes—cranial MRI, and muscle biopsy were normal. She received various unsuccessful trials with diazepam, trihexyphenidyl, botulinum toxin, and opioid and nonopioid analgesics. Depressive symptoms improved only mildly with fluoxetine. Preoperative examination disclosed dysphonia, left torticollis and laterocollis, left shoulder elevation, and dystonic postural tremor in both arms (torticollis rating scale of Tsui et al.4 [RST] total score = 21; Hamilton depression score = 36). Palpation over dystonic muscles reproduced the pain that brought the patient to …
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