TY  - JOUR
A1  - Odorfer, Thorsten M.
A1  - Volkmann, Jens
T1  - Deep brain stimulation for focal or segmental craniocervical dystonia in patients who have failed botulinum neurotoxin therapy - a narrative review of the literature
T2  - Toxins
N2  - (1) Background: The first-line treatment for patients with focal or segmental dystonia with a craniocervical distribution is still the intramuscular injection of botulinum neurotoxin (BoNT). However, some patients experience primary or secondary treatment failure from this potential immunogenic therapy. Deep brain stimulation (DBS) may then be used as a backup strategy in this situation. (2) Methods: Here, we reviewed the current study literature to answer a specific question regarding the efficacy and safety of the use of DBS, particularly for cervical dystonia (CD) and Meige syndrome (MS) in patients with documented treatment failure under BoNT. (3) Results: There are only two studies with the highest level of evidence in this area. Despite this clear limitation, in the context of the narrowly defined research question of this paper, it is possible to report 161 patients with CD or MS who were included in studies that were able to show a statistically significant reduction in dystonic symptoms using DBS. Safety and tolerability data appeared adequate. However, much of the information is based on retrospective observations. (4) Conclusions: The evidence base in this area is in need of further scientific investigation. Most importantly, more randomized, controlled and double-blind trials are needed, possibly including a head-to-head comparison of DBS and BoNT.
KW  - cervical dystonia
KW  - Meige syndrome
KW  - deep brain stimulation
KW  - internal globus pallidus
KW  - subthalamic nucleus
KW  - botulinum neurotoxin
KW  - medication therapy failure
KW  - symptom control
KW  - safety and tolerability
Y1  - 2023
UR  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/35770
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-357707
SN  - 2072-6651
VL  - 15
IS  - 10
ER  -