Authors' objectives:

This report is intended to assess the efficacy of deep brain stimulation (DBS) for the treatment of dystonias and to determine the validated indications for the procedure.

Authors' results and conclusions: One hundred and forty five articles related with the subject were identified, 51 of them reported data on the usefulness of DBS in the treatment of dystonia. Only one controlled randomized trial was found which compared different brain stimulation frequencies. No systematic reviews were identified. DBS has been reported as beneficial mainly in patients with primary dystonia, showing an improvement in motion range between 50 and 90%. Children and DYT-gene carriers would benefit the most. For secondary dystonia, results are less conclusive and most of the reports show a lower effect, being minimal in secondary dystonias with brain structure lesions. Though results from the research studies analyzed are promising, their methodological quality is poor. In general, they are case series or case reports where patient selection is subjected to several biases; the population is generally very small; results are measured using different scales and in some cases subjectively; in most of them, follow-up is incomplete; and the DBS technique has not been properly described in many publications. There are no studies that adequately compare DBS with ablative procedures or drug therapies. Coverage of this technology is not homogeneous. There are policies for and against it. There are still not enough studies which may allow to clearly identify the patients who could more likely benefit from this intervention. It is currently proposed for patients over seven with drug-resistant chronic untreatable primary dystonia, generalized or segmental dystonia and cervical dystonia.

Authors' recommendations: Although there is some evidence suggesting positive results with potentially low risks, it is not enough to suggest the routine use of this technology. For this reason, together with the high cost of the procedure, DBS is not homogeneously covered by the different health organizations surveyed. Most primary dystonias (approximately 90%) are adequately controlled with oral drugs, that is why, added to the low prevalence of the disease, this should not be a procedure to be frequently performed.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)