Deep brain stimulation for the treatment of patients with dystonia: advances towards network-based personalised care

Dystonia is a complex movement disorder that can cause functional disability and reduce quality of life. Deep brain stimulation (DBS) provides meaningful benefits in patients with medically refractory dystonia, but clinical outcomes can vary substantially. This variability likely reflects the heterogeneity in clinical presentations, genetic background, and brain networks involved in motor control. Dystonia is a network disorder involving abnormal interactions across cortico-basal ganglia-cerebellar circuits. Therapeutic effects of DBS therefore arise from modulation of distributed motor circuits rather than a single anatomical target. Advances in non-invasive neurophysiological techniques, intraoperative recordings, and connectome-based neuroimaging have provided new insights into how DBS modulates these pathological networks. Individual response to DBS and long-term outcomes are shaped by the interaction between clinical and genetic factors, neurophysiological abnormalities, and distributed network connectivity. Combining these variables can help refine patient selection for clinical studies and support individualised neuromodulation strategies.