Putamen Atrophy as a Predictive Factor of Efficacy of GPi-DBS in Dystonia-Dyskinesia Syndrome Secondary to Perinatal Anoxic Encephalopathy.

BACKGROUND

Perinatal hypoxic-ischemic encephalopathy (HIE) is a severe condition resulting from impaired oxygen delivery to the developing brain, often leading to both motor deficits and dystonia-dyskinetic syndromes (DDS). In selected cases, deep brain stimulation of the globus pallidus internus (GPi-DBS) may provide a therapeutic option. However, predicting outcomes remains challenging because of clinical heterogeneity and variable responses.

OBJECTIVES

This retrospective study aims to identify preoperative imaging predictors of GPi-DBS efficacy in patients with DDS secondary to HIE, focusing on putaminal atrophy as a potential criterion.

METHODS

We retrospectively analyzed 73 patients with DDS secondary to HIE who underwent GPi-DBS at our institution from 2003 to 2023. Clinical outcomes were assessed using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Barry-Albright Dystonia Scale (BADS) at baseline and up to 15 years post-surgery. Preoperative magnetic resonance imaging scans were qualitatively and quantitatively evaluated to assess putaminal atrophy. Statistical analyses explored the relationships between imaging findings, clinical severity, and DBS outcomes.

RESULTS

Patients with severe putaminal atrophy exhibited significantly higher preoperative BFMDRS motor and disability scores, correlating with a limited response to DBS at 1-year follow-up (P < 0.05). Volumetric analysis confirmed that greater putaminal atrophy was associated with poorer motor improvements post-surgery. The predictive value of putaminal volume for long-term outcomes remained significant at 5-year follow-up.

CONCLUSIONS

Putaminal atrophy is a key predictor of suboptimal outcomes following GPi-DBS in patients with HIE-related DDS. These findings highlight the importance of preoperative imaging in candidate selection and underscore the need for alternative strategies in patients with severe post-anoxic basal ganglia damage. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.