{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T17:57:38Z","timestamp":1788890258346,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T00:00:00Z","timestamp":1626912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>There is no available data on the journey of dystonia patients once referred to a tertiary center to undergo deep brain stimulation (DBS). We hypothesized that some patients might be incorrectly diagnosed while others might decline the procedure or experience significant benefit with switching to a different botulinum neurotoxin (BoNT). This is a single-center, retrospective study of dystonia patients who were referred to the DBS program between January 2014 and December 2018. We collected data on the surgical decision as well as factors influencing this decision. Sixty-seven patients were included (30 males, mean age: 48.3 \u00b1 20.1 years, disease duration: 16.9 \u00b1 15.3 years). Thirty-three (49%) patients underwent DBS. Four (6%) patients were awaiting the procedure while the remaining 30 patients (45%) did not undergo DBS. Reasons for DBS decline were patient refusal (17, 53%), functional dystonia (6, 20%), and successful use of AbobotulinumtoxinA (3, 10%) in patients who had failed other BoNTs. Our study highlights the importance of structured patient education to increase acceptance of DBS, as well as careful patient evaluation, particularly with respect to functional dystonia. Finally, changing BoNT formulation might be beneficial in some patients.<\/jats:p>","DOI":"10.3390\/toxins13080511","type":"journal-article","created":{"date-parts":[[2021,7,22]],"date-time":"2021-07-22T22:37:14Z","timestamp":1626993434000},"page":"511","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Factors Influencing the Surgical Decision in Dystonia Patients Referred for Deep Brain Stimulation"],"prefix":"10.3390","volume":"13","author":[{"given":"Carolina","family":"Gorodetsky","sequence":"first","affiliation":[{"name":"Division of Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada"},{"name":"Edmond J. Safra Program in Parkinson\u2019s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurology, University of Toronto, Toronto, ON M5S 3H2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Azevedo","sequence":"additional","affiliation":[{"name":"Edmond J. Safra Program in Parkinson\u2019s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurology, University of Toronto, Toronto, ON M5S 3H2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Candeias da Silva","sequence":"additional","affiliation":[{"name":"Edmond J. Safra Program in Parkinson\u2019s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurology, University of Toronto, Toronto, ON M5S 3H2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5346-0180","authenticated-orcid":false,"given":"Alfonso","family":"Fasano","sequence":"additional","affiliation":[{"name":"Division of Neurology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada"},{"name":"Edmond J. Safra Program in Parkinson\u2019s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurology, University of Toronto, Toronto, ON M5S 3H2, Canada"},{"name":"Krembil Brain Institute, Toronto, ON M5T 1M8, Canada"},{"name":"Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON M5T 1M8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,22]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Dystonia","volume":"4","author":"Balint","year":"2018","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.parkreldis.2006.12.013","article-title":"How Many Parkinsonian Patients Are Suitable Candidates for Deep Brain Stimulation of Subthalamic Nucleus? Results of a Questionnaire","volume":"13","author":"Morgante","year":"2007","journal-title":"Park. Relat. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.parkreldis.2014.09.034","article-title":"Factors Influencing Secondary Non-Response to Botulinum Toxin Type A Injections in Cervical Dystonia","volume":"21","author":"Ferreira","year":"2015","journal-title":"Park. Relat. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Bellows, S., and Jankovic, J. (2019). Toxins Immunogenicity Associated with Botulinum Toxin Treatment. Toxins, 11.","DOI":"10.3390\/toxins11090491"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1016\/j.toxicon.2018.01.019","article-title":"Evidence on Botulinum Toxin in Selected Disorders","volume":"147","author":"Zakin","year":"2018","journal-title":"Toxicon"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1212\/WNL.0000000000002560","article-title":"Practice Guideline Update Summary: Botulinum Neurotoxin for the Treatment of Blepharospasm, Cervical Dystonia, Adult Spasticity, and Headache Report of the Guideline Development Subcommittee of the American Academy of Neurology","volume":"86","author":"Simpson","year":"2016","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fneur.2017.00035","article-title":"Clinical Practice: Evidence-Based Recommendations for the Treatment of Cervical Dystonia with Botulinum Toxin","volume":"8","author":"Contarino","year":"2017","journal-title":"Front. Neurol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1097\/WCO.0b013e32832dc169","article-title":"Psychogenic Movement Disorders","volume":"22","author":"Gupta","year":"2009","journal-title":"Curr. Opin. Neurol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"27","DOI":"10.14802\/jmd.19064","article-title":"Principles of Electrophysiological Assessments for Movement Disorders","volume":"13","author":"Chen","year":"2020","journal-title":"J. Mov. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12883-017-0820-7","article-title":"How to Improve Patient Education on Deep Brain Stimulation in Parkinson\u2019s Disease: The CARE Monitor Study","volume":"17","author":"Dinkelbach","year":"2017","journal-title":"BMC Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.parkreldis.2015.11.010","article-title":"Patients\u2019 Reluctance to Undergo Deep Brain Stimulation for Parkinson\u2019s Disease","volume":"23","author":"Kim","year":"2016","journal-title":"Park. Relat. Disord."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Espay, A.J., and Lang, A.E. (2015). Phenotype-Specific Diagnosis of Functional (Psychogenic) Movement Disorders. Curr. Neurol. Neurosci. Rep.","DOI":"10.1007\/s11910-015-0556-y"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/j.ncl.2020.01.011","article-title":"Treatment of Functional Movement Disorders","volume":"38","author":"LaFaver","year":"2020","journal-title":"Neurol. Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.parkreldis.2017.06.023","article-title":"Causes of Failure of Pallidal Deep Brain Stimulation in Cases with Pre-Operative Diagnosis of Isolated Dystonia","volume":"43","author":"Pauls","year":"2017","journal-title":"Park. Relat. Disord."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Morigaki, R., Miyamoto, R., Mure, H., Fujita, K., Matsuda, T., Yamamoto, Y., Nakataki, M., Okahisa, T., Matsumoto, Y., and Miyake, K. (2020). Can Pallidal Deep Brain Stimulation Rescue Borderline Dystonia? Possible Coexistence of Functional (Psychogenic) and Organic Components. Brain Sci., 10.","DOI":"10.3390\/brainsci10090636"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S66","DOI":"10.1016\/j.parkreldis.2017.06.025","article-title":"Dystonia: Then and Now","volume":"46","author":"Comella","year":"2018","journal-title":"Park. Relat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Fasano, A., Paramanandam, V., and Jog, M. (2020). Use of Abobotulinumtoxina in Adults with Cervical Dystonia: A Systematic Literature Review. Toxins, 12.","DOI":"10.3390\/toxins12080470"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1002\/mds.26085","article-title":"Dysport and Botox at a Ratio of 2.5: 1 Units in Cervical Dystonia: A Double-Blind, Randomized Study","volume":"30","author":"Yun","year":"2015","journal-title":"Mov. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1136\/jnnp.64.1.6","article-title":"A Double Blind, Randomised, Parallel Group Study to Investigate the Dose Equivalence of Dysport\u00ae and Botox\u00ae in the Treatment of Cervical Dystonia","volume":"64","author":"Odergren","year":"1998","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/WNF.0000000000000107","article-title":"Comparison between Dysport and Prosigne in the Treatment of Cervical Dystonia","volume":"38","author":"Barbosa","year":"2015","journal-title":"Clin. Neuropharmacol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Rodrigues, F.B., Duarte, G.S., Marques, R.E., Castel\u00e3o, M., Ferreira, J., Sampaio, C., Moore, A.P., and Costa, J. (2020). Botulinum Toxin Type A Therapy for Cervical Dystonia. Cochrane Database Syst. Rev.","DOI":"10.1002\/14651858.CD003633.pub4"},{"key":"ref_22","first-page":"459","article-title":"Respective Potencies of Botox and Dysport: A Double Blind, Randomised, Crossover Study in Cervical Dystonia","volume":"72","author":"Ranoux","year":"2002","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1002\/mds.870120414","article-title":"Teaching Tape for the Motor Section of the Toronto Western Spasmodic Torticollis Scale","volume":"12","author":"Cornelia","year":"1997","journal-title":"Mov. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1212\/WNL.35.1.73","article-title":"Validity and Reliability of a Rating Scale for the Primary Torsion Dystonias","volume":"35","author":"Burke","year":"1985","journal-title":"Neurology"}],"container-title":["Toxins"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6651\/13\/8\/511\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:33:11Z","timestamp":1760164391000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6651\/13\/8\/511"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,22]]},"references-count":24,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["toxins13080511"],"URL":"https:\/\/doi.org\/10.3390\/toxins13080511","relation":{},"ISSN":["2072-6651"],"issn-type":[{"value":"2072-6651","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,22]]}}}