State of the Art - Tiefe Hirnstimulation bei dystonen Bewegungsstörungen

Dystonic disorders comprise heterogenous movement disorders, reflecting different disease entities. They are accompanied by significant loss of quality of life and may lead to significant motor disablement including wheel chair dependency. Medical therapeutic options are limited especially in generalized dystonia. The introduction of deep brain stimulation for the treatment of movement disorders (e.g. essential tremor and advanced Parkinson}s disease) has opened new therapeutic avenues also for dystonic disorders. Thus, brain regions deeply located in the brain may be functionally influenced by the reversible application of electrical charge via stereotactically implanted electrodes (deep brain stimulation) without structurally lesioning brain tissue. In two multicenter, blinded studies, an improvement of dystonic symptoms in patients with primary generalized or segmental dystonia of approximately 50 % following deep brain stimulation of the internal pallidum has been documented, which led to approval of deep brain stimulation in the EU for treatment of primary generalized and segmental dystonias. The following review summarizes the results and the perspectives of deep brain stimulation in dystonia.