Deep Brain Stimulation for Residual Spasmodic Torticollis after Selective Peripheral Denervation

Moon, Ji Young; Han, In Bo; Chung, Young Sun; Chung, Sang Sup; Huh, Ryoong

Case report

Journal of the Korean Society of Stereotactic and Functional Neurosurgery 2006;2(2):185-188.
Published online September 30, 2006.

Deep Brain Stimulation for Residual Spasmodic Torticollis after Selective Peripheral Denervation

Ji Young Moon, In Bo Han, Young Sun Chung, Sang Sup Chung, Ryoong Huh

Department of Neurosurgery, Bundang CHA Hospital, Pochon CHA Medical University, Seongnam, Korea

Abstract

Deep brain stimulation (DBS) is well established for Parkinson's disease and essential tremor, and has widened the spectrum of therapeutic options for patients with intractable dystonia. We present one patient with spasmodic torticollis, which was successfully treated by bilateral pallidal DBS. A 30-year-old male had suffered from jerky head movement and periodic unnatural postioning of the head for 2 years. Neurological examination disclosed rotatory torticollis to the right side. The patient initially had received clonazepam and anticholinergic drug, and later had undergone botulinum toxin injection. Because there was no response, selective peripheral denervation was initially performed. After surgery, there was only a limited effect and the level of social-occupational adaptation was low. Therefore, the patient underwent DBS of the globus pallidus internus (Gpi) at 17 months after selective peripheral denervation. A marked improvement of the symptoms was observed six days after the initiation of Gpi-DBS, and additional progressive improvement was noted during follow-up period. Bilateral stimulation of Gpi can be a very useful treatment option in spasmodic torticollis, even in patients who do not respond to selective denervation.

Key Words: Deep brain stimulation, Spasmodic torticollis.