Dystonia

Dystonia is a multifaceted movement disorder causing a range of types of involuntary movement. Two axes are used to distinguish different subtypes of dystonia: clinical aspects (time of onset and distribution of symptoms) and etiology (e.g., primary vs. secondary). Patients who are not adequately treated with medical therapy are referred for surgical treatment, which primarily consists of deep brain stimulation. The pallidum is the most common target for treatment of dystonia and has been shown to be effective for the heterogenous group of dystonia disorders. Other deep brain stimulation targets can also be considered. Deep brain stimulation can be performed using a variety of techniques, both awake and asleep, both with and without microelectrode recording, with a frame and frameless, and with a variety of image-guided approaches. There are some special considerations for dystonia patients that should be considered when determining the appropriate surgical treatment. New techniques for ablation have reintroduced pallidotomy as a potential surgical treatment in select cases.