Impact of Bilateral GPi Deep Brain Stimulation on Dystonia, Functional Outcomes, and Caregiver Burden in Patients with Dystonic Cerebral Palsy

Background: Dystonic cerebral palsy (DCP) is a complex, disabling manifestation of secondary dystonia, which significantly impacts motor function, quality of life, and caregiver wellbeing. Conventional pharmacologic therapies frequently do not relieve symptoms sufficiently. Deep brain stimulation (DBS) of the globus pallidus internal segment (GPi) has garnered increasing attention as a neuromodulatory treatment for refractory dystonia. Still, the experience in the effect of Gpi DBS treatment in adults with DCP has, until recently, been limited. Methods: We performed a retrospective, two-center case series of 11 adult patients with medically refractory DCP who underwent bilateral GPi-DBS. The clinical outcomes were evaluated based on the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), the Functional İndependence Measure (FIM), the Gross Motor Function Classification System (GMFCS), and the Caregiver Burden Scale (CBS. The assessments were done preoperatively and at 1-year follow-up. Changes in continuous variables were analyzed using paired t-tests. Results: At the 1-year follow-up, the mean BFMDRS score improved from 69.6 ± 27.6 to 54.3 ± 36.5 (p = 0.001), significantly reducing overall dystonia severity. Functional independence also improved, demonstrated by the rise in FIM scores from 65.3 ± 33.9 to 79.2 ± 43.4 (p = 0.006). Although GMFCS levels did not change in most patients (p = 0.125), the burden on caregivers reduced significantly, with CBS scores falling from 35.7 ± 18.8 to 32.0 ± 17.1 (p = 0.015). There were no surgical  complications. Conclusion: In adults, DCP, bilateral GPi-DBS is a safe and effective intervention that improves motor control and increases functional independence with  decreased caregiver burden. These findings lend support to its role in the multidisciplinary management of DCP.