Comparison of Pallidal Deep Brain Stimulation and Bilateral Pallidotomy for Medically Refractory Status Dystonicus: A Systematic Review and Meta-Analysis

PurposeStatus dystonicus (SD) is a medical emergency that results from a primary or secondary dystonia condition and is life-threatening if untreated. Surgical intervention is indicated for swift resolution of medically refractory SD. This study looks to compare bilateral pallidotomy against deep brain stimulation (DBS) for SD treatment. MethodsA meta-analysis was conducted according to PRISMA guidelines. Terms "pallidotomy", "deep brain stimulation" and "status dystonicus" were used on January 2nd, 2024 to search PubMed, EMBASE, Scopus and Web of Science. All article data was uploaded to the systematic review software Rayyan where duplicates were removed with three independent reviewers screening remaining articles. Data was manually collected after quality assessment and analyzed using meta-analysis of proportions of pooled complications and continuous meta-analysis of one of two movement disorder scores. ResultsForty-three total patients (32 DBS and 11 pallidotomy; 27 male and 16 female) were included. Average age of SD onset was 12.49 {+/-} 8.55 years (11.95 {+/-} 9.69 for DBS and 13.71 {+/-} 5.30 for pallidotomy) Change in movement disorder score was 48 {+/-} 34% overall (54 {+/-} 33% for DBS and 34 {+/-} 33% for pallidotomy). A subgroup meta-analysis showed a standardized mean difference of changes in movement disorder score of - 1.55 [-2.97, -0.13] for DBS and -1.35 [-2.40, -0.30] (p=0.83). A meta-analysis of proportions showed a 40% complication rate for DBS and 16% complication rate for pallidotomy (p=0.14). ConclusionThere is insufficient evidence to determine if there is a difference between pallidotomy or DBS for SD treatment, but these results suggest that pallidotomy may be a valid alternative in resource-limited settings or when DBS is contraindicated, although further comparative studies are needed.