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“Sustained Relief after Discontinuation of DBS for Dystonia: Implications for the Possible Role of Synaptic Plasticity and Cortical Reorganization”

The authors report a single case of secondary segmental dystonia after mild cervical trauma. After initiation of bilateral deep brain stimulation (DBS) to the globus pallidus internus (GPi) the patient showed clinical improvement. After a secondary loss of beneficial effects, the system was switched off unbeknown to the patient. Despite this, the patient's condition remained improved for more than 6 months. The authors lead an interesting discussion over the pathophysiology of the dystonias. In their opinion the clinical course indicates “plastic changes through DBS” in the neuronal circuitry as the most likely explanation.

This is a well-written report of only limited novelty. However, in the slowly growing literature that occasionally reports sustained benefit after discontinuation of DBS in this disease, this article represents another small but nevertheless important contribution. The long-term effects of DBS especially for the different types of dystonias are far away from being fully understood. It remains a puzzle, why sustained effects are reported predominantly in this disease.[1] Moreover, why do we not see those plastic changes in other target sites being stimulated with DBS for other conditions? In my eyes it is a clear limitation of this report that a case of secondary dystonia (with problems like the question for trauma mechanisms and possible neurotic components) is presented. However, the interesting overview over ideas on dystonia physiology then again makes the article more palatable.

• Reference

• 1 Foote KD, Sanchez JC, Okun MS. Staged deep brain stimulation for refractory craniofacial dystonia with blepharospasm: case report and physiology. Neurosurgery 2005; 56 (2) E415 , discussion E415
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