Ann Rehabil Med.  2011 Oct;35(5):742-746. 10.5535/arm.2011.35.5.742.

Combined Therapy of Orthopedic Surgery after Deep Brain Stimulation in Cerebral Palsy Mixed Type: A Case Report

  • 1Department & Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea.
  • 2Department of Neurosurgery, Yonsei University College of Medicine, Seoul 120-752, Korea.
  • 3Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul 120-752, Korea.


Dystonia is a symptom defined by involuntary and irregular contractions of the muscles, which cause movement disorders and postural problems. Deep brain stimulation (DBS) in globus pallidus interna (GPi) is a good option for controlling dystonia. DBS has already been shown to have significant effects on primary dystonia as well as Parkinson's disease. Dystonia is very difficult to manage, as seen in cerebral palsy (CP) mixed with spasticity. As CP patients grow, their musculoskeletal problems may require orthopedic surgery. However, the outcome of orthopedic surgery is not usually suitable due to dystonia. Therefore, we attempted to control dystonia through DBS initially and perform orthopedic surgery to correct musculoskeletal deformities after treatment of dystonia. Herein, we report a case that showed remarkable improvement in terms of the dystonia rating scale and gait pattern after combined therapy of DBS and orthopedic surgery.


Dystonia; Deep brain stimulation; Cerebral palsy

MeSH Terms

Cerebral Palsy
Congenital Abnormalities
Deep Brain Stimulation
Dystonic Disorders
Globus Pallidus
Movement Disorders
Muscle Spasticity
Parkinson Disease


  • Fig. 1 Kinematic Changes in Gait Analysis after Combined Therapy of DBS and Orthopedic Surgery. When compared with preoperative state (A), pelvic bump sign, asymmetry of pelvic obliquity and ankle plantar flexion deformity were attenuated after orthopedic surgery performed 6 months after treatment of dystonia with DBS (B). DBS: Deep brain stimulation.


1. Koman LA, Smith BP, Shilt JS. Cerebral palsy. Lancet. 2004; 363:1619–1631. PMID: 15145637.
2. Monbaliu E, Ortibus E, Roelens F, Desloovere K, Deklerck J, Prinzie P, de Cock P, Feys H. Rating scales for dystonia in cerebral palsy: reliability and validity. Dev Med Child Neurol. 2010; 52:570–575. PMID: 20132143.
3. Cif L, El Fertit H, Vayssiere N, Hemm S, Hardouin E, Gannau A, Tuffery S, Coubes P. Treatment of dystonic syndromes by chronic electrical stimulation of the internal globus pallidus. J Neurosurg Sci. 2003; 47:52–55. PMID: 12900733.
4. Vidailhet M, Vercueil L, Houeto JL, Krystkowiak P, Benabid AL, Cornu P, Lagrange C, Tezenas du Montcel S, Dormont D, Grand S, et al. Bilateral deepbrain stimulation of the globus pallidus in primary generalized dystonia. N Engl J Med. 2005; 352:459–467. PMID: 15689584.
5. Kupsch A, Benecke R, Muller J, Trottenberg T, Schneider GH, Poewe W, Eisner W, Wolters A, Muller JU, Deuschl G, et al. Pallidal deep-brain stimulation in primary generalized or segmental dystonia. N Engl J Med. 2006; 355:1978–1990. PMID: 17093249.
6. Vercueil L, Krack P, Pollak P. Results of deep brain stimulation for dystonia: a critical reappraisal. Mov Disord. 2002; 17(Suppl 3):S89–S93. PMID: 11948761.
7. Vidailhet M, Yelnik J, Lagrange C, Fraix V, Grabli D, Thobois S, Burbaud P, Welter ML, Xie-Brustolin J, Braga MC, et al. Bilateral pallidal deep brain stimulation for the treatment of patients with dystonia choreoathetosis cerebral palsy: a prospective pilot study. Lancet Neurol. 2009; 8:709–717. PMID: 19576854.
8. Zorzi G, Marras C, Nardocci N, Franzini A, Chiapparini L, Maccagnano E, Angelini L, Caldiroli D, Broggi G. Stimulation of the globus pallidus internus for childhood-onset dystonia. Mov Disord. 2005; 20:1194–1200. PMID: 15895426.
9. Starr PA, Turner RS, Rau G, Lindsey N, Heath S, Volz M, Ostrem JL, Marks WJ Jr. Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes. J Neurosurg. 2006; 104:488–501. PMID: 16619651.
10. Krauss JK, Loher TJ, Weigel R, Capelle HH, Weber S, Burgunder JM. Chronic stimulation of the globus pallidus internus for treatment of non-DYT1 generalized dystonia and choreoathetosis: 2-year follow up. J Neurosurg. 2003; 98:785–792. PMID: 12691403.
Full Text Links
  • ARM
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: