| Sumario: | Objective To investigate long-term efficacy and safety of bilateral globus pallidus internus deep brain stimulation (GPi-DBS) for spasmodic torticollis (ST), and to evaluate its impact on patients' quality of life, emotional state, and cognitive function. Methods A retrospective analysis was conducted on the clinical data of 41 patients with spasmodic torticollis who underwent bilateral GPi-DBS in The Affiliated Brain Hospital of Nanjing Medical University from September 2016 to July 2022. Follow-up assessments were performed preoperatively and at 3, 6, 12, 24 and 36 months postoperatively. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was used to assess motor function and pain. The Craniocervical Dystonia Questionnaire-24 (CDQ-24) was used to assess quality of life. The Hamilton Anxiety Rating Scale (HAMA), Hamilton Depression Rating Scale (HAMD), and Mini-Mental State Examination (MMSE) were used to assess neuropsychiatric and cognitive functions. Results There were significant differences before and after surgery in the total TWSTRS score (P = 0.000) and its subscale scores for severity (P = 0.000), disability (P = 0.000) and pain (P = 0.000), as well as CDQ-24 (P = 0.000), HAMA (P = 0.000), HAMD (P = 0.000) and MMSE (P = 0.001) scores. Compared with preoperative baselines, the total TWSTRS score (P = 0.000, for all), subscale scores for severity (P = 0.000, for all), disability (P = 0.000, for all) and pain (P = 0.001, 0.001, 0.001, 0.004, 0.001), along with CDQ -24 (P = 0.000, for all), HAMA (P = 0.000, for all), HAMD (P = 0.000, for all) significantly decreased at 3, 6, 12, 24 and 36 months postoperatively. Meanwhile, although MMSE score exhibited statistical fluctuations during the follow -up period (P = 0.007, 0.000, 0.007, 0.011, 0.026), they all remained within the normal range without clear clinical significance. Compared with those at 3 months postoperatively, the total TWSTRS score (P = 0.000, for all), subscale scores for severity (P = 0.000, for all), disability (P = 0.000, for all) and pain (P = 0.018, 0.018, 0.014, 0.007), as well as CDQ-24 (P = 0.000, for all), HAMA (P = 0.000, for all), and HAMD (P = 0.000, 0.001, 0.000, 0.000) scores further decreased at 6, 12, 24 and 36 months postoperatively. Compared with those at 6 months postoperatively, the total TWSTRS score (P = 0.000, for all) and subscale scores for severity (P = 0.000, for all) and disability (P = 0.000, for all) further decreased at 12, 24 and 36 months postoperatively; additionally, CDQ-24 (P = 0.004, 0.018) and HAMA (P = 0.004, 0.017) scores showed further decreased at 12 and 36 months postoperatively. At the 36-month postoperative follow-up, the total TWSTRS score showed an average improvement of 63.18% compared with preoperative baseline, with subscale scores for severity, disability and pain improving by 65.82%, 62.09% and 51.72%, respectively; meanwhile, CDQ-24, HAMA and HAMD scores improved by 51.54%, 45.38% and 32.70%, respectively. Conclusions Bilateral GPi-DBS demonstrates significant and sustained long-term efficacy in the treatment of spasmodic torticollis. It effectively improves motor symptoms, alleviates pain, and enhances quality of life without impairing cognitive function, demonstrating a favorable safety profile.
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