Objetivos para el tratamiento de la distonía causada por varias etiologías. Metaanálisis

Abstract

Introduction: To use a meta-analysis on all reported cases of deep brain stimulation (DBS) for dystonia to reevaluate the good effect using the GPi as a target, which factors significant influence outcome related to the target. The Burke-Fahn-Marsden (BFM) movement scale, the most reported measure, was chosen as the primary outcome measure for this analysis. Material and Methods: Computerized MEDLINE searches on English literature search identified 137 patients who underwent BBS for dystonia in 24 studies that had individual BFM scores. The study was done with statistical analysis by intention to treat. Statistical analysis was made with a significant p- value of 0.05. For the comparison of pre- and postoperative scores, a test Wilcoxon signed was used. Results: The mean BFM percentage change (improvement in postoperative score from baseline) was 46.3%(range - 34% to 100%). At last follow-up, disease severity and the degree of disability and pain on the BFM were significantly improved by 70.4%, and 67.8%, respectively (p < 0.05, Wilcoxon signed-rank test).   significantly better outcomeswere achieved with stimulation of the globus pallidus internus (GPI) than with stimulation of the posterior portion of the ventral lateral (VLp) nucleus of the thalamus (p < 0.05). The etiology of the dystonia also had a significant effect on outcomes. Statistically significant improvements in outcomes were seen for all etiologic categories, except encephalitis. Dystonia due to birth injury and encephalitis had significantly worse outcomes of patients who were DYT1, or had pantothenate-kinase-associated
neurodegeneration (PKAN), tardive dyskinesia, and idiopathic and posttraumatic dystonias. Longer duration of dystonia symptons
correlated negatively with surgical outcome. Conclusion: Deep Brain stimulation of the GPi provides improvement in BFM scores in a variety of dystonic conditions.