AUTHOR=Je Goun , Miocinovic Svjetlana , Huang Vicki , Aia Pratibha G. , Tripathi Richa , Buetefisch Cathrin M. , Esper Christine D. , Higginbotham Lenora A. , Triche Shirley , Factor Stewart A. , Radmard Sara 
  
TITLE=The long-term efficacy of globus pallidus deep brain stimulation in tardive dystonia and dyskinesia
  
JOURNAL=Dystonia
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/dystonia/articles/10.3389/dyst.2026.17246
  
DOI=10.3389/dyst.2026.17246
  
ISSN=2813-2106
  
ABSTRACT=IntroductionTardive syndromes, including tardive dystonia (TDyst) and tardive dyskinesia (TDysk), are complications of exposure to dopamine receptor blocking agents (DRBAs) and remain common despite the use of second-generation antipsychotics. Approximately one-quarter of patients exposed to DRBAs may develop TDysk. Globus pallidus internus deep brain stimulation (GPi DBS) has emerged as a therapeutic option for medically refractory TDyst and TDysk, although data on long-term outcomes and effective stimulation sites remain limited.MethodsWe retrospectively reviewed clinical data for 18 patients with medically refractory TDyst/TDysk, who underwent GPi DBS at a single center. Clinical outcomes were assessed preoperatively and at 11.1 ± 3.2 months, 35.9 ± 5.1 months, and 62.5 ± 7.6 months follow-up using Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) in patients with TDyst, Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) in patients with prominent tardive cervical dystonia, and Abnormal Involuntary Movement Scale (AIMS) in patients with TDysk. Active electrode contact locations and stimulation parameters at the last follow-up were also evaluated.ResultsThe mean duration of tardive symptoms before surgery was 9.0 ± 7.9 years. BFMDRS motor scores improved significantly after GPi DBS, decreasing from 27.5 ± 8.3 preoperatively to 9.1 ± 7.5, 5.0 ± 5.8, and 4.1 ± 7.6 at follow-up visits, respectively. Axial and extremity BFMDRS subscores showed significant improvement, whereas speech, swallowing and orofacial dystonia subscores showed numerical improvement without reaching statistical significance. TWSTRS and AIMS scores also demonstrated numerical improvement with limited statistical interpretation due to the small number of available scores.ConclusionGPi DBS resulted in robust and sustained long-term improvement in medically refractory TDyst, with potential benefit in TDysk. These findings support GPi DBS as a safe and effective therapeutic option for selected patients with severe treatment-refractory tardive syndromes. Earlier surgical intervention may be considered to facilitate timely symptomatic relief and durable long-term benefit.