What type of brain surgery is best for dystonia?
Evidence is starting to accumulate that the best brain region for surgery for generalized dystonia (dystonia affecting the whole body) is the globus pallidus. This is a peanut-sized structure deep in the brain whose electrical activity is abnormal in dystonia. For dystonias affecting mainly the neck and face, hower, the optimal target is less clear. Although DBS of the globus pallidus often improves the dystonia, there can also be subtle impairments (slowing down) of previously normal limbs with this techniques. Therefore, for patients with dystonia affecting mainly the neck and face, we are offering enrollment in a clinical trial of subthalamic nucleus DBS. This target may prove to be better tolerated for neck dystonia, but the the clinical study is not complete. While the older lesioning technique and the newer DBS technique can both be effective, we usually prefer DBS over lesioning because it is reversible and adjustable, and does not permanently destroy any part of the brain. Thus
