Rescue globus pallidus deep brain stimulation following refractory dystonia treated with subthalamic nucleus deep brain stimulation: illustrative case.

BACKGROUND: Dystonia is a group of movement disorders that can result in tremor, abnormal posturing, and difficulty with coordinated movements. Medically intractable dystonia can be treated with deep brain stimulation (DBS). Dystonia refractory to DBS can be rescued with DBS to another region. Here, the authors report one of the first cases of dystonia initially treated with subthalamic nucleus (STN) DBS rescued by globus pallidus (GPi) DBS.

OBSERVATIONS: A 42-year-old male presented with progressive and disabling left hemidystonia along with toe curling, foot inversion, and arm posturing. Previous therapies include botulinum toxin, phenol injections, and bilateral STN-DBS. STN-DBS initially provided relief with symptoms, but its effect faded over time. Multiple attempts were made to optimize lead placement, but they were ultimately unsuccessful. Bilateral GPi-DBS was performed through several programming sessions. A brain laboratory lead localization and brain sense survey were performed to determine the ideal settings. The patient demonstrated significant improvements with his more severe symptoms and is now regaining a better quality of life.

LESSONS: There have been several cases of refractory dystonia following GPi-DBS being rescued by STN-DBS. However, there have been no cases describing GPi-DBS rescuing dystonia refractory to STN-DBS. This case provides insight into a novel method of treating dystonia refractory to STN-DBS. https://thejns.org/doi/10.3171/CASE24886.