The globus pallidus internus (GPi) has been the primary target for deep brain stimulation (DBS) to treat severe medication–refractory dystonia. Some patients with primary cervical dystonia do not respond adequately to GPi stimulation. Subthalamic nucleus (STN) DBS may provide an alternative choice for treating this dystonia. In this study, we analysed the effect of bilateral STN DBS on two patients of medically refractory primary cervical dystonia. The severity of the dystonia was measured using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) preoperatively, and 1, 3, 6 and 12 months postoperatively and yearly follow-up was performed. Any change in mental status was recorded using the Mini-Mental State Examination (MMSE) score. Surgery was performed using the Leksell stereotactic system and by fusing CT scan and MR images with neuronavigation and microelectrode recording. Both patients were followed for more than 3 years. STN DBS was well-tolerated by both patients with no adverse effects. The benefit seems to be immediate. The first patient showed 74% improvement, and the second patient showed 84.3% improvement in the overall TWSTRS score. No mental deterioration was observed in either of the cases, as the MMSE score remained unchanged in both patients. A prior bilateral pallidal lesion in the first case did not adversely affect the outcome. This study showed that bilateral STN DBS results in a very significant improvement in cervical dystonia with no mental worsening and suggests that STN DBS may be an alternative to GPi DBS for treating primary cervical dystonia.

苍白球内侧（GPi）已成为治疗严重药物难治性肌张力障碍的深部脑刺激（DBS）的主要靶标。一些原发性宫颈肌张力障碍患者对GPi刺激反应不充分。丘脑底核（STN）DBS可能为治疗这种肌张力障碍提供替代选择。在这项研究中，我们分析了双侧STN DBS对两名难治性原发性宫颈肌张力障碍患者的影响。术前使用多伦多西部痉挛性斜颈评分量表（TWSTRS）测量肌张力障碍的严重程度，并在术后1、3、6和12个月进行一次年度随访。使用迷你精神状态检查（MMSE）分数记录任何精神状态的变化。手术使用Leksell立体定位系统，并将CT扫描和MR图像与神经导航和微电极记录融合在一起进行。两名患者均被随访了3年以上。两名患者对STN DBS的耐受性良好，没有不良反应。好处似乎是立竿见影的。第一位患者的总TWSTRS得分提高了74％，第二位患者的总STRSTRS得分提高了84.3％。在这两种情况下，均未观察到精神恶化，因为两名患者的MMSE评分均保持不变。在第一例中，先前的双侧苍白病灶对结果没有不利影响。这项研究表明，双侧STN DBS可以显着改善宫颈肌张力障碍，而不会导致精神恶化，并且表明STN DBS可以替代GPi DBS治疗原发性宫颈肌张力障碍。