الفهرس 
Anatomical and physiological considerationsOnly 14 pages are availabe for public view
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Abstract
Background:
Secondary dystonia are the syndromes that have dystonic symptoms due to brain insult which can be associated with neonatal encephalopathy syndromes, trauma, vascular injury, infections, demyelinations, or hereditary disorders associated with neurodegenerative process. The disability inflected by dystonia encouraged the development of many neurosurgical procedures in order to improve the quality of life of these patients.
The aim of this study was to compare the outcomes of different Neuroablative and modulation techniques in treatment of secondary dystonia.
Patients and methods
This is a prospective study included 120 patients suffering from intractable secondary dystonia. Ablative techniques included the brain lesioning procedure and combined anterior and posterior lumbar rhizotomy (CAPR). Modulation techniques included deep brain stimulation (DBS) and intrathecal baclofen therapy (ITB). Patients with focal dystonia were included in the Botulinum toxin injection group. Patients with generalized dystonia were included in either of the brain lesioning or the deep brain stimulation, and patients with predominant affection of both lower limbs were included in either of the (CAPR) or the (ITB) groups.
Assessment measures included the evaluation of the muscle tone, range of motion, and the Burke-Fahn-Marsden dystonia rating scale through a follow up period of one year.
Results
Muscle tone was significantly reduced in the ablative techniques and the ITB, but the changes in the DBS group were not significant. The range of motion improved in all groups; the changes were significant in the ablative techniques and the ITB but were not significant in the DBS group. The BFMDRS showed improvement in all groups, the changes were significant in all groups except the DBS group.
Conclusion
Both neuroablative and neuromodulation techniques have the beneficial impact on secondary dystonias especially with stationary neurological pathologies with no significant statistical difference between both techniques.
While the neuromodulation techniques had the advantages of being adjustable, titratable, reversible, and can be performed bilaterally.