What is the history of surgery for dystonia?

Brain operations to treat various forms of dystonia were first performed 40-50 years ago. The operations involved a precisely controlled lesioning (destruction) of deep structures in the brain involved in movement control. Two different deep structures, called the thalamus, and the globus pallidus, were operated upon. Lesioning was performed by freezing or coagulation. Surgical techniques were much less advanced in that era that they are today, so the result were not consistent and complications were frequent.

 

In the past 15 years there has been a resurgence of interest in surgical treatments for dystonia. This is due to several reasons, including improved precision and safety in techniques for operating in deep brain structures, and the development of deep brain stimulation (DBS), which involves placing a stimulation electrode rather than performing a lesion. DBS can alter the electrical activity of abnormal brain tissue in a way that improves movement, but it is reversible if there is an unwanted side effect, and it can be adjusted (or programmed) to optimize the degree of benefit. It is hence safer than lesioning. Since 1995, several publications in neurology and neurosurgery journals have shown that deep brain stimulation for several different types of dystonia can be effective.