Anterior capsulotomy combined with subthalamic nucleus deep brain stimulation for tardive dystonia

Background: Deep brain stimulation (DBS) has been reported as a therapy option for the motor dysfunction of severe tardive dystonia (TD). The major psychiatric diseases, however, are contraindications to DBS treatment in TD patients. Methods: Six severe, medically refractory TD patients undergoing bilateral anterior capsulotomy combined with bilateral subthalamic nucleus (STN)-DBS treatment were studied retrospectively at two time points: preoperation, and 1 -3 years post-operation. Burke -Fahn -Marsden Dystonia Rating Scale (BFMDRS) was used to assess the dystonia and disability. Depressive, anxiety, psychiatric symptoms, and Quality of Life (QoL) were evaluated using the 17 -item Hamilton Depression Scale (HAMD-17), the 14 -item Hamilton Anxiety Scale (HAMA-14), the Positive and Negative Syndrome Scale (PANSS), and 36 -item Short-Form Health Survey (SF-36), respectively. Results: After receiving the combination treatment for 25 +/- 11.6 months (range, 12 -41 months), significant clinical symptom improvements were reported in TD patients. BFMDRS motor and disability scores were ameliorated by 78.5 +/- 32.0% ( p = 0.031) and 76.5 +/- 38.6% ( p = 0.031), respectively. The HAMD-17 and HAMA-14 scores were reduced by 60.3 +/- 27.9% ( p = 0.007) and 60.0 +/- 24.6% ( p = 0.009), respectively. Furthermore, the PANSS scores of the comorbidity schizophrenia TD patients decreased by 58.1 +/- 6.0% ( p = 0.022), and the QoL improved by 59.7 +/- 14.1% (SF-36, p = 0.0001). During the research, there were no notable adverse effects or problems. Conclusion: Bilateral anterior capsulotomy combined with bilateral STN-DBS may be an effective and relatively safe treatment option for severe TD comorbid with major psychiatric disorders.