Journal
MOVEMENT DISORDERS
Volume 28, Issue 5, Pages 647-654Publisher
WILEY
DOI: 10.1002/mds.25339
Keywords
meta-analysis; deep brain stimulation; dyskinetic cerebral palsy
Categories
Funding
- Medtronic
- German Research Foundation (DFG)
- Walter- and Marga-Boll-StiftungPfizer
- Turner-Syndrom-Vereinigung Deutschland e.V.
- Medtronic Ltd.
- Medtronic Inc
- Boston Scientific
- Bayer Healthcare
- UCB Schwarz Pharma
- TEVA Pharma
- Lundbeck Pharma
- Bracco
- Gianni PR
- Medas Pharma
- Desitin Pharma
- Boehringer Ingelheim
- GlaxoSmithKline
- Eumecom
- Orion Pharma
- Cephalon
- Abott
- GE Medical
- German Research Foundation
- German Ministry of Education and Research
- Manfred und Ursula Muller Stiftung
- Kluh Stiftung
- Hoffnungsbaum e.V.
- NBIA DISORDERS SOCIETY USA
- Koln Fortune
- Deutsche Parkinson Vereinigung
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Secondary dystonia encompasses a heterogeneous group with different etiologies. Cerebral palsy is the most common cause. Pharmacological treatment is often unsatisfactory. There are only limited data on the therapeutic outcomes of deep brain stimulation in dyskinetic cerebral palsy. The published literature regarding deep brain stimulation and secondary dystonia was reviewed in a meta-analysis to reevaluate the effect on cerebral palsy. The Burke-Fahn-Marsden Dystonia Rating Scale movement score was chosen as the primary outcome measure. Outcome over time was evaluated and summarized by mixed-model repeated-measures analysis, paired Student t test, and Pearson's correlation coefficient. Twenty articles comprising 68 patients with cerebral palsy undergoing deep brain stimulation assessed by the Burke-Fahn-Marsden Dystonia Rating Scale were identified. Most articles were case reports reflecting great variability in the score and duration of follow-up. The mean Burke-Fahn-Marsden Dystonia Rating Scale movement score was 64.94 +/- 25.40 preoperatively and dropped to 50.5 +/- 26.77 postoperatively, with a mean improvement of 23.6% (P < .001) at a median follow-up of 12 months. The mean Burke-Fahn-Marsden Dystonia Rating Scale disability score was 18.54 +/- 6.15 preoperatively and 16.83 +/- 6.42 postoperatively, with a mean improvement of 9.2% (P < .001). There was a significant negative correlation between severity of dystonia and clinical outcome (P < .05). Deep brain stimulation can be an effective treatment option for dyskinetic cerebral palsy. In view of the heterogeneous data, a prospective study with a large cohort of patients in a standardized setting with a multidisciplinary approach would be helpful in further evaluating the role of deep brain stimulation in cerebral palsy. (c) 2013 Movement Disorder Society
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