{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:00:37Z","timestamp":1789970437355,"version":"4.0.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Dystonia"],"abstract":"<jats:p>Pallidal deep brain stimulation (DBS) is effective for treating cranial or craniocervical dystonia, a disorder characterized by abnormal facial expressions, impaired eyelid opening, speech and chewing difficulties, and abnormal head posture, leading to physical disability and functional impairment. However, long-term data on motor, non-motor, and quality-of-life outcomes remain limited with less robust available data than cervical dystonia. In 19 patients with craniocervical dystonia, the Unified Dystonia Rating Scale (UDRS) scores improved by 34.5% at 3\u20136 months, 51.0% at 1\u20132 years, 33.3% at 3\u20135 years, and 43.4% at the most recent follow-up (median of individual improvements). Body region analysis showed that the proportion of patients classified as DBS responders, defined by a \u226525\u201330% improvement in UDRS scores, ranged from 31.2% to 43.8% at 3\u20136 months, increasing to a range of 50%\u201383.3% by the 6\u20139-year follow-up. Alongside motor improvements, trends in depression and social quality-of-life domain improvements were noted with more robust changes likely limited by sample size and the lack of disease specific metrics. Longer therapy duration appeared to enhance the magnitude of gains. Overall, pallidal DBS improves motor function and daily activities in craniocervical dystonia, with durable and potentially progressive long-term benefits.<\/jats:p>","DOI":"10.3389\/dyst.2026.16756","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:10:15Z","timestamp":1789967415000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond the neck: long-term motor and non-motor outcomes of pallidal DBS in craniocervical dystonia"],"prefix":"10.3389","volume":"5","author":[{"given":"Matthew","family":"Remz","sequence":"first","affiliation":[{"name":"Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida","place":["Gainesville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Zeilman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida","place":["Gainesville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samyukta","family":"Senthil","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida","place":["Gainesville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida","place":["Gainesville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Gerzenshtein","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida","place":["Gainesville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikaru","family":"Kamo","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida","place":["Gainesville, FL, United States"]},{"name":"Department of Neurology, Juntendo University School of Medicine","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparna","family":"Wagle Shukla","sequence":"additional","affiliation":[{"name":"Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida","place":["Gainesville, FL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1002\/mdc3.70390","article-title":"Segmental and multifocal isolated dystonias: similarities and differences","volume":"13","author":"Jinnah","year":"2025","journal-title":"Mov Disord Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","first-page":"10359","DOI":"10.3389\/dyst.2022.10359","article-title":"Clinical features and evolution of blepharospasm: a multicenter international cohort and systematic literature review","volume":"1","author":"Scorr","year":"2022","journal-title":"Dystonia"},{"key":"B3","doi-asserted-by":"publisher","first-page":"700714","DOI":"10.3389\/fneur.2021.700714","article-title":"Oromandibular dystonia: a clinical examination of 2,020 cases","volume":"12","author":"Scorr","year":"2021","journal-title":"Front Neurol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"jnnp-2020","DOI":"10.1136\/jnnp-2020-325193","article-title":"Quality of life in isolated dystonia: non-motor manifestations matter","author":"Junker","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1007\/s00415-023-12022-4","article-title":"Longitudinal predictors of health-related quality of life in isolated dystonia","volume":"271","author":"Junker","year":"2024","journal-title":"J Neurol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"286","DOI":"10.7916\/D8H41Q4X","article-title":"Comparable botulinum toxin outcomes between primary and secondary blepharospasm: a retrospective analysis","volume":"4","author":"Martinez-Ramirez","year":"2014","journal-title":"Tremor Other Hyperkinet Mov (N Y)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"11361","DOI":"10.3389\/dyst.2023.11361","article-title":"Case report: lingual dystonia symptoms treated with botulinum toxin in patients with THAP1 mutation","volume":"2","author":"Wagle Shukla","year":"2024","journal-title":"Dystonia"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1278","DOI":"10.1007\/s00415-020-09703-9","article-title":"A pooled meta-analysis of GPi and STN deep brain stimulation outcomes for cervical dystonia","volume":"267","author":"Tsuboi","year":"2020","journal-title":"J Neurol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1038\/s41531-025-01015-x","article-title":"Patient, target, device, and program selection for DBS in parkinson's disease: advancing toward precision care","volume":"11","author":"Wagle Shukla","year":"2025","journal-title":"NPJ Parkinsons Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"679918","DOI":"10.3389\/fneur.2021.679918","article-title":"Evolution of globus pallidus targeting for parkinson's and dystonia deep brain stimulation: a 15-Year experience","volume":"12","author":"Holanda","year":"2021","journal-title":"Front Neurol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1002\/mds.10377","article-title":"Rating scales for dystonia: a multicenter assessment","volume":"18","author":"Comella","year":"2003","journal-title":"Mov Disord"},{"key":"B12","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.parkreldis.2019.04.024","article-title":"Importance of the initial response to GPi deep brain stimulation in dystonia: a nine year quality of life study","volume":"64","author":"Tsuboi","year":"2019","journal-title":"Parkinsonism Relat Disord"},{"key":"B13","volume-title":"Gait and Balance in Cervical Dystonia and Dystonic Head Tremor","author":"Aparna","year":"2023"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1002\/mds.30130","article-title":"Long-term outcomes on pallidal neurostimulation for dystonia: a controlled, prospective 10-Year Follow-Up","volume":"40","author":"Krause","year":"2025","journal-title":"Mov Disord"},{"key":"B15","doi-asserted-by":"publisher","first-page":"110958","DOI":"10.1016\/j.jocn.2024.110958","article-title":"Subthalamic nucleus versus globus pallidus internus deep brain stimulation in the treatment of dystonia: a systematic review and meta-analysis of safety and efficacy","volume":"132","author":"Yousef","year":"2025","journal-title":"J Clin Neurosci"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2287","DOI":"10.1007\/s00701-022-05320-9","article-title":"Outcome of pallidal deep brain stimulation for treating isolated orofacial dystonia","volume":"164","author":"Huh","year":"2022","journal-title":"Acta Neurochir (Wien)"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e16121","DOI":"10.1111\/ene.16121","article-title":"Subthalamic nucleus deep brain stimulation in primary meige syndrome: motor and non-motor outcomes","volume":"31","author":"Hao","year":"2024","journal-title":"Eur J Neurol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1007\/s10072-024-07752-w","article-title":"Deep brain stimulation and pallidotomy in primary meige syndrome: a prospective cohort study","volume":"46","author":"Hao","year":"2025","journal-title":"Neurol Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1016\/j.neurom.2024.02.002","article-title":"Long-term efficacy of bilateral globus pallidus stimulation in the treatment of meige syndrome","volume":"28","author":"Fu","year":"2025","journal-title":"Neuromodulation"},{"key":"B20","doi-asserted-by":"publisher","first-page":"63","DOI":"10.3171\/2024.12.JNS241739","article-title":"Clinical outcomes and prognostic factors in patients with primary meige syndrome undergoing subthalamic nucleus deep brain stimulation: a retrospective study of 65 cases","volume":"143","author":"Feng","year":"2025","journal-title":"J Neurosurg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2025.9.JNS251420","article-title":"Globus pallidus internus versus subthalamic nucleus deep brain stimulation for Meige syndrome: a retrospective study on short- and long-term efficacy","volume":"144","author":"Wu","year":"2026","journal-title":"J Neurosurg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3171\/2017.7.JNS17323","article-title":"Long-term outcome of pallidal stimulation for Meige syndrome","volume":"130","author":"Horisawa","year":"2019","journal-title":"J Neurosurg"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.3171\/2024.9.JNS241430","article-title":"Prognostic factors for long-term outcomes of bilateral pallidal deep brain stimulation in the treatment of Meige syndrome","volume":"142","author":"Zheng","year":"2025","journal-title":"J Neurosurg"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2025.9.JNS251188","article-title":"Pallidus internus versus subthalamic nucleus deep brain stimulation for Meige syndrome: a randomized, controlled, double-blind multicenter trial","volume":"144","author":"Wu","year":"2026","journal-title":"J Neurosurg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1227\/neu.0000000000003783","article-title":"Comparison of pallidal and subthalamic stimulation for cranial cervical dystonia: a 4-Year Follow-up study","volume":"99","author":"Huang","year":"2026","journal-title":"Neurosurgery"},{"key":"B26","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1055\/s-0041-1735856","article-title":"Should the globus pallidus targeting be refined in dystonia?","volume":"83","author":"da Silva Lapa","year":"2022","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2106","DOI":"10.1093\/brain\/awr122","article-title":"Shaping reversibility? long-term deep brain stimulation in dystonia: the relationship between effects on electrophysiology and clinical symptoms","volume":"134","author":"Ruge","year":"2011","journal-title":"Brain"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1136\/jnnp-2017-317098","article-title":"Physiological effects of subthalamic nucleus deep brain stimulation surgery in cervical dystonia","volume":"89","author":"Wagle Shukla","year":"2018","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1136\/jnnp-2020-323701","article-title":"Pallidal deep brain stimulation in primary Meige syndrome: clinical outcomes and psychiatric features","volume":"91","author":"Hao","year":"2020","journal-title":"J Neurol Neurosurg Psychiatry"}],"container-title":["Dystonia"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/dyst.2026.16756\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:10:17Z","timestamp":1789967417000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/dyst.2026.16756\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":29,"alternative-id":["10.3389\/dyst.2026.16756"],"URL":"https:\/\/doi.org\/10.3389\/dyst.2026.16756","relation":{},"ISSN":["2813-2106"],"issn-type":[{"value":"2813-2106","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"article-number":"16756"}}