Objective: To report a case of severe generalized dystonia secondary to anoxic brain injury treated successfully with bilateral globus pallidus interna (GPi) deep brain stimulation (DBS)

Background: Severe adult-onset dystonia secondary to anoxic brain injury is comparatively rare. There have been case reports of pediatric dystonia secondary to genetic disorders being treated with GPi DBS but very few reports of successful DBS to treat adult onset secondary dystonia. We present this case report to provide a possible treatment avenue for adult onset secondary generalized dystonia.

Methods: A fifty year-old woman suffered a respiratory arrest. There was no prior personal or family history of dystonia. With intensive rehabilitation patient was able to ambulate with assistance six weeks after arrest. However nine to ten weeks post arrest, she developed persistent hyperextension of spine, severe rigidity of paraspinal muscles, plantar flexion of lower extremities, hyperreflexia and inability to ambulate despite full strength and sensation. Work up revealed normal renal/liver function and creatine kinase. Initial post arrest brain magnetic resonance imaging revealed restricted diffusion in the putamen and caudate nuclei bilaterally consistent with anoxic brain injury. Imaging prior to surgery revealed bilateral caudate putaminal T2 hyper-intensity without restricted diffusion. She required intubation and propofol infusion due to status dystonicus. Patient was treated with amantadine, baclofen, benztropine via gastrostomy tube and scheduled intravenous lorazepam with only mild improvement in dystonia. Bilateral GPi DBS with pulse generator placement was performed, the stimulator was turned on the next day and doses of sedatives were successfully reduced.

Results: Adult-onset severe dystonia secondary to anoxic brain injury significantly improved with the placement of bilateral GPi DBS electrodes. Patient was discharged with improved quality of life and amelioration of pain.

Conclusions: Bilateral GPi DBS may be considered as a treatment modality for adults with generalized dystonia secondary to anoxic brain injury.

« Back to 2018 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/deep-brain-stimulation-a-treatment-modality-for-generalized-dystonia-secondary-to-anoxic-brain-injury-in-adults/