Beyond the Neck: Long-Term Motor and Non-motor Outcomes of Pallidal DBS in Craniocervical Dystonia.

Pallidal deep brain stimulation (DBS) is effective for treating cranial or craniocervical dystonia, a disorder characterized by abnormal facial expressions, impaired eyelid opening, speech and chewing difficulties, and abnormal head posture, leading to physical disability and functional impairment. However, long-term data on motor, non-motor, and quality-of-life outcomes remain limited with less robust available data than cervical dystonia. In 19 patients with craniocervical dystonia, the Unified Dystonia Rating Scale (UDRS) scores improved by 34.5% at 3-6 months, 51.0% at 1-2 years, 33.3% at 3-5 years, and 43.4% at the most recent follow-up (median of individual improvements). Body region analysis showed that the proportion of patients classified as DBS responders, defined by a ≥ 25-30% improvement in UDRS scores, ranged from 31.2% to 43.8% at 3-6 months, increasing to a range of 50% to 83.3% by the 6-9-year follow-up. Alongside motor improvements, trends in depression and social quality-of-life domain improvements were noted with more robust changes likely limited by sample size and the lack of disease specific metrics. Longer therapy duration appeared to enhance the magnitude of gains. Overall, pallidal DBS improves motor function and daily activities in craniocervical dystonia, with durable and potentially progressive long-term benefits.