Analysis of Bilateral Stereotactic Pallidotomy in Patients Presenting with Generalized Dystonia


  • Muhammad Hassan Raza
  • Hassan Ali Khosa
  • Hassaan Zahid
  • Asad Shah
  • Adeeb-ul-Hassan
  • Khalid Mahmood



Stereotactic pallidotomy, Burke-Marsden-Fahn Dystonia Scale score, generalized dystonia


Objective: To find the improvement with stereotactic pallidotomy. The main aim of the study was to assess the outcome based on mean change in Burke-Marsden-Fahn Dystonia Scale (BMFDS) score after stereotactic pallidotomy in patients presenting with generalized dystonia.

Material & Methods:  Quasi-experimental study was conducted over five years at Unit II, Department of Neurosurgery, Lahore General Hospital, Lahore. A total of 16 patients 9 were males and 6 were female meeting inclusion criteria of age 20-70years of either gender presenting with generalized dystonia for at least 6 months. Patients underwent stereotactic pallidotomy. Furthermore, Patients with coagulopathies (PT, apt > 4 sec deranged), Patients with a history of trauma, Patients with CVA (on history), and patients having intracranial pathology (trauma/hematoma) were excluded. BMFDS score was noted at baseline and after 3 months of surgery, and change in BMFDS was noted. The questionnaire was used to collect information. SPSS Version 21 was used to examine the data that had been gathered.

Results:  The patients' average age was 47.35 and 14.40 years. There were 19 (31.67%) males and 41 (68.33%) females. The mean duration of dystonia was 15.43 ± 6.13 months. At baseline, the mean BMFDS was 49.67 ± 5.69 which was reduced to 18.03 ± 3.35. The mean change in BMFDS was 31.63 ± 6.38. There was a significant change in BMFDS (p < 0.05).

Conclusion:  Hence, in patients with generalized dystonia, stereotactic pallidotomy is beneficial in lowering the BMFDS score by more than 50%.


Centen LM, Oterdoom DM, Tijssen MA, Lesman?Leegte I, van Egmond ME, van Dijk JMC. Bilateral pallidotomy for dystonia: a systematic review. Movement Disorders, 2021; 36 (3): 547-57.

Wojtasiewicz T, Butala A, Anderson WS. Dystonia. Stereotactic and Functional Neurosurgery: Springer; 2020: p. 311-27.

Horisawa S, Fukui A, Takeda N, Kawamata T, Taira T. Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia. Annals of Clinical and Translational Neurology, 2021; 8( 4): 857-65.

Cury RG, Kalia SK, Shah BB, Jimenez-Shahed J, Prashanth LK, Moro E. Surgical treatment of dystonia. Expert Review of Neurotherapeutics, 2018; 18 (6): 477-92.

Taira T, Horisawa S, Takeda N, Ghate P. Stereotactic radiofrequency lesioning for movement disorders. Current Concepts in Movement Disorder Management, 2018; 33: 107-19.

Hariz M. Pallidotomy for Dystonia: A Neglected Procedure? Movement Disorders. 2021;36(3):533.

Gupta A. Subthalamic stimulation for cervical

dystonia. Acta Neurochirurgica. 2020; 162 (8): 1879-81.

Ostrem JL, San Luciano M, Dodenhoff KA, Ziman N, Markun LC, Racine CA, et al. Subthalamic nucleus deep brain stimulation in isolated dystonia: a 3-year follow-up study. Neurology, 2017; 88 (1): 25-35.

Sobstyl MR, S?awek JW, Z?bek M. The neurosurgical treatment of patients in dystonic state–Overview of the literature. Neurologia i Neurochirurgia Polska, 2014; 48 (1): 63-70.

Levi V, Zorzi G, Messina G, Romito L, Tramacere I, Dones I, et al. Deep brain stimulation versus pallidotomy for status dystonicus: a single-center case series. Journal of Neurosurgery, 2019; 134 (1): 197-207.

Tomasz M, Szalecki K, Koziara H, Soltan E, Krolicki B, Czapski B, et al. Pallidal or Subthalamic Deep Brain Stimulation for the Generalized Dystonia Treatment. Journal of Neurology & Neurophysiology, 2016; 7 (3): 1-5.

Wolf ME, Capelle H-H, Lütjens G, Ebert AD, Hennerici MG, Krauss JK, et al. Body weight gain in patients with bilateral deep brain stimulation for dystonia. Journal of Neural Transmission, 2016; 123 (3): 261-7.

Horisawa S, Goto S, Nakajima T, Kawamata T, Taira T. Bilateral stereotactic thalamotomy for bilateral musician's hand dystonia. World Neurosurgery, 2016; 92: 585. e21-. e25.






Original Articles