Cervical Dystonia Clinical Trial
Official title:
Prospective,Randomised, Double-blind, Multicenter Study to Assess the Efficacy and Safety of Bilateral Globus Pallidus Internus - in Patients With Medically Refractory Primary Cervical Dystonia
The purpose of this study is to investigate the efficacy and safety of bilateral pallidal stimulation in patients with medically refractory primary cervical dystonia.
Primary cervical dystonia (CD) affects about 20-40/100.000 population. The disease is chronic
and life-long. The therapy of choice are local intramuscular Botulinum Toxin injections given
every three months. Oral medication such as anticholinergics or dopamine depleting drugs are
usually of limited efficacy or their use is limited by intolerable side-effects. About 5-10%
of CD patients develop neutralizing antibodies against Botulinum Toxin. Two previous
controlled multicenter trials have shown the efficacy and safety of bilateral pallidal
stimulation in patients with primary segmental and generalized dystonia (one study was
performed by our group).
Following surgery, patients will be randomized 1:1 to verum or placebo stimulation for a
period of three months. Primary outcome measure is the TWSTRS (Toronto Western Spasmodic
Torticollis Rating Scale) - a validated and widely accepted physician-based outcome measure
for cervical dystonia. The independent TWSTRS raters are movement disorders specialists
unaware of the stimulation status (verum/placebo) and they compare the TWSTRS-score at
baseline and 3-months follow-up. Our hypothesis is that stimulated patients will have a
significantly better improvement of dystonia as compared to those without stimulation
(placebo group).
After the 3-months period, all patients are unblinded and receive continuous effective
stimulation by the implanted system. Regular follow-up visits are scheduled every 12 months
for 5 years postoperatively to assess the long-term efficacy of pallidal stimulation.
Side-effects are assessed in a standardized way and include the assessment of surgery-induced
as well as stimulation-induced side-effects.
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