Bilateral pallidal deep brain stimulation versus bilateral pallidotomy in the management of post anoxic generalized dystonia.

BACKGROUND Post-anoxic acquired generalized dystonia is a rare and severely disabling condition in which medical therapy is often ineffective. Pallidal deep brain stimulation (DBS) is widely used for generalized dystonia; however, its efficacy in acquired dystonia is less well established, and access may be limited in resource-constrained settings. Bilateral posteroventral pallidotomy (PVP) represents a potential alternative, but comparative data between the two approaches in post-anoxic dystonia are lacking.

OBJECTIVE To compare clinical outcomes and safety profiles of bilateral globus pallidus internus deep brain stimulation (GPi-DBS) and bilateral simultaneous posteroventral pallidotomy (PVP) in patients with post-anoxic acquired generalized dystonia.

METHODS A retrospective cohort study was conducted including patients with post-anoxic generalized dystonia who underwent bilateral GPi-DBS or bilateral simultaneous PVP between June 2014 and December 2025. Outcomes were assessed using the Burke-Fahn-Marsden Movement Scale (BFM-MS) and Disability Scale (BFM-DS) at baseline and 1-year follow-up. Within- and between-group comparisons were performed, and procedure-related adverse events were recorded.

RESULTS Twenty-three patients (mean age 19.1 ± 6.6 years) were included: 10 underwent GPi-DBS and 13 underwent PVP. Both groups demonstrated significant improvement in BFM-MS and BFM-DS scores at 1 year compared with baseline (p < 0.01). Improvement in BFM-MS scores was significantly greater in the PVP group (p = 0.021), while no significant difference was observed in BFM-DS improvement (p = 0.707). One permanent visual field deficit occurred in the PVP group, and one hardware-related infection occurred in the DBS group.

CONCLUSION Both GPi-DBS and PVP were associated with significant clinical improvement in post-anoxic acquired generalized dystonia. PVP may represent a reasonable alternative in carefully selected patients, particularly in resource-limited settings.