Objective: To summarize, assess and perform a quantitative analysis of the available evidence on the effectiveness and safety of deep brain stimulation on improving dystonia severity and its impact on the quality of life of patients with medically refractory dystonia.

Background: Dystonia is a genetically associated hyperkinetic movement disorder characterized by abnormal often, twisting movements and sustained postures from co-contraction of antagonistic muscles. It results in significant disability in at least 0.01-0.02% of the general population. Deep brain stimulation have shown promising utility in the treatment of dystonia.

Methods: Literature search was made using the key words “deep brain stimulation” and “dystonia” on several online databases. Randomized controlled trials on the effectiveness of deep brain stimulation on dystonia were selected and appraised. Quantitative analysis was done with disease severity in the form of the clinical global impression score as the primary outcome. The impact on quality of life was analyzed through the eight domains of the SF-36 questionnaire and the adverse effects of the intervention were tabulated.

Results: The studies showed a significant decrease in dystonia severity at three months of pallidal neurostimulation by both patient (-2.89 [-3.71, -2.07], I2 = 51%, P for heterogeneity = 0.15, p-value < 0.00001) and physician (-2.71 [-3.25, -2.16], I2 = 48%, P for heterogeneity = 0.17, p-value < 0.00001) ratings. Significant improvement in quality of life was seen on the physical function (9.97 [1.19, 18.75], I2 = 80%, P for heterogeneity=0.03, p-value=0.03), general health (9.29 [2.65, 15.94], I2 = 29%, P for heterogeneity = 0.24, p-value=0.006) and vitality (6.77 [0.04, 13.50], I2 = 33%, P for heterogeneity = 0.22, p-value=0.05) domains. Common adverse effects are device infection and dysarthria.

Conclusions: Deep brain stimulation is effective in reducing disease severity in medically refractory dystonia. It has some positive impact on the physical function, general health and vitality of patients. It should be offered as a treatment option for cases of medically-refractory dystonia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effectiveness-of-deep-brain-stimulation-on-dystonia-a-meta-analysis/