Botulinum Toxin and Deep Brain Stimulation in Dystonia
Julia Carvalhinho Carlos de Souza,
Ananda Carolina Moraes Falcone,
Renata Montes Garcia Barbosa,
Miriam Carvalho Soares,
Renato Munhoz,
Marina Farah,
Tamine Capato,
Sara Carvalho Barbosa Casagrande,
Marcela Ferreira Cordellini,
Gabriel de Castro Micheli,
João Carlos Papaterra Limongi,
Egberto Reis Barbosa,
Clarice Listik,
Rubens Gisbert Cury
Affiliations
Julia Carvalhinho Carlos de Souza
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Ananda Carolina Moraes Falcone
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Renata Montes Garcia Barbosa
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Miriam Carvalho Soares
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Renato Munhoz
Morton and Gloria Shulman Movement Disorders Centre and the Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada
Marina Farah
Cajuru University Hospital, Pontíficia Universidade Católica do Paraná, Curitiba 80050-350, Brazil
Tamine Capato
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Sara Carvalho Barbosa Casagrande
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Marcela Ferreira Cordellini
Instituto de Neurologia de Curitiba, Curitiba 81210-310, Brazil
Gabriel de Castro Micheli
Department of Neurology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro 21941-617, Brazil
João Carlos Papaterra Limongi
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Egberto Reis Barbosa
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Clarice Listik
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Rubens Gisbert Cury
Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo 05403-000, Brazil
Deep Brain Stimulation (DBS) is a recognized treatment for different dystonia subtypes and has been approved by the Food and Drug Administration (FDA) since 2003. The European Federation of Neurological Societies (EFNS) and the International Parkinson and Movement Disorders Society (MDS) recommend DBS for dystonia after failure of botulinum toxin (BoNT) and other oral medications for dystonia treatment. In addition, several long-term studies have demonstrated the continuous efficacy of DBS on motor and quality of life (QoL) scores. However, there are only a few reports comparing the overall impact of surgical treatment in BoNT protocols (e.g., dosage and number of selected muscles before and after surgery). This retrospective multicenter chart-review study analyzed botulinum toxin total dosage and dosage per muscle in 23 dystonic patients before and after DBS surgery. The study’s primary outcome was to analyze whether there was a reduction in BoNT dosage after DBS surgery. The mean BoNT dosages difference between baseline and post-surgery was 293.4 units for 6 months, 292.6 units for 12 months, and 295.2 units at the last visit. The median total dose of BoNT in the preoperative period was 800 units (N = 23). At the last visit, the median was 700 units (p = 0.05). This represents a 12.5% reduction in BoNT median dosage. In conclusion, despite the limitations of this retrospective study, there was a significant reduction in BoNT doses after DBS surgery in patients with generalized dystonia.
