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Nijenhuis B, van Wensen E, Smit M, van Zutphen T, Zwerver J, Tijssen M. Treatment of task-specific dystonia in sports: A systematic review. Clin Park Relat Disord 2024; 10:100245. [PMID: 38456155 PMCID: PMC10918566 DOI: 10.1016/j.prdoa.2024.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 11/30/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Task specific dystonia is a movement disorder only affecting a highly practiced skill and is found in a broad set of expert movements including in sports. Despite affecting many sports, there is no comprehensive review of treatment options, which is in contrast to better studied forms of task specific dystonia in musicians and writers. For this reason, studies involving an intervention to treat task specific dystonia in sports were systematically reviewed, with special attention for the quality of outcome measures. Methods The PICO systematic search strategy was employed on task-specific dystonia, and all synonyms. Inclusion criteria were peer reviewed published studies pertaining to sports, studies with a measurement and/or intervention in TSD, all in English. We excluded abstracts, expert opinions, narrative review articles, unpublished studies, dissertations and studies exclusively relating to choking. We included case reports, case studies and case-control studies. Results In April 2022 Pubmed, Embase, Web of Science, and Psychinfo were searched. Of the 7000 articles identified, 31 were included that described psychological and invasive and/or pharmacological interventions. There was a lack of formal standardized outcome measures in studies resulting in low quality evidence for the effectiveness of treatment options. A descriptive synthesis showed emotional regulation was effective, but was exclusively tried in golfers. Interventions like botulinum toxin or pharmacology had a similar effectiveness compared to studies in musicians dystonia, however there was almost no formal evidence for these treatments. Conclusion The quality of studies was low with a lack of standardized outcome measures. Future studies with larger cohorts and quantitative outcome measures are needed to improve understanding of treatments for task specific dystonia in athletes.
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Affiliation(s)
- B. Nijenhuis
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- University of Groningen/Faculty Campus Fryslân, Leeuwarden, The Netherlands
| | - E. van Wensen
- Department of Neurology, Gelre Ziekenhuizen Apeldoorn and Sports Dystonia Centre, Apeldoorn, The Netherlands
| | - M. Smit
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - T. van Zutphen
- University of Groningen/Faculty Campus Fryslân, Leeuwarden, The Netherlands
| | - J. Zwerver
- Sports Valley, Sports Medicine, Gelderse Vallei Hospital, Ede, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M.A.J. Tijssen
- Department of Neurology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Expertise Center Movement Disorders Groningen, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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Maamary J, Peters J, Kyle K, Ruge D, Jonker B, Barnett Y, Tisch S. Evaluation of the efficacy and safety of MRI-guided focused ultrasound (MRgFUS) for focal hand dystonia: study protocol for an open-label non-randomised clinical trial. BMJ Neurol Open 2023; 5:e000522. [PMID: 37900622 PMCID: PMC10603452 DOI: 10.1136/bmjno-2023-000522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/23/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction MRI-guided focused ultrasound (MRgFUS) thalamotomy provides an exciting development in the field of minimally invasive stereotactic neurosurgery. Current treatment options for focal hand dystonia are limited, with potentially more effective invasive stereotactic interventions, such as deep brain stimulation or lesional therapies, rarely used. The advent of minimally invasive brain lesioning provides a potentially safe and effective treatment approach with a recent pilot study establishing MRgFUS Vo-complex thalamotomy as an effective treatment option for focal hand dystonia. In this study, we undertake an open-label clinical trial to further establish MRgFUS Vo-complex thalamotomy as an effective treatment for focal hand dystonia with greater attention paid to potential motor costs associated with this treatment. To elucidate pathophysiology of dystonia and treatment mechanisms, neurophysiological and MRI analysis will be performed longitudinally to explore the hypothesis that neuroplastic and structural changes that may underlie this treatment benefit. Methods and analysis A total of 10 participants will be recruited into this open-label clinical trial. All participants will undergo clinical, kinemetric, neurophysiological and radiological testing at baseline, followed by repeated measures at predesignated time points post MRgFUS Vo-complex thalamotomy. Further, to identify any underlying structural or neurophysiological abnormalities present in individuals with focal hand dystonia, 10 age and gender matched control participants will be recruited to undergo comparative investigation. These results will be compared with the intervention participants both at baseline and at 12 months to assess for normalisation of these abnormalities, if present. Ethics and dissemination This trial was reviewed and approved by the St Vincent's Health Network Sydney Human Research Ethics Committee (2022/ETH00778). Study results will be published in peer-reviewed journals and presented at both national and international conferences. Trial registration number CTRN12622000775718.
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Affiliation(s)
- Joel Maamary
- Department of Neurology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - James Peters
- Department of Neurology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kain Kyle
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Diane Ruge
- Laboratoire de Recherche en Neurosciences Cliniques, Montpellier, France
| | - Benjamin Jonker
- Department of Neurosurgery, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Yael Barnett
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Stephen Tisch
- Department of Neurology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
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Nishitani M, Horisawa S, Nonaka T, Kohara K, Mochizuki T, Kawamata T, Taira T. Pistol Shooting Dystonia Treated with Thalamotomy. Tremor Other Hyperkinet Mov (N Y) 2023; 13:32. [PMID: 37692072 PMCID: PMC10487115 DOI: 10.5334/tohm.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/22/2023] [Indexed: 09/12/2023] Open
Abstract
Background Neurosurgical treatment for pistol shooting dystonia has not been studied. Case report The patient was a 41-year-old woman who participated in the Olympic Games four times as a shooting player. Five months after the final Tokyo Olympic trials, she developed dystonia of the right index finger when shooting. Stereotactic thalamotomy was performed, and a complete resolution of dystonia was achieved. She garnered her personal best score and placed fifth in the Tokyo Olympics. Discussion Thalamotomy along with deep brain stimulation can be a surgical modality for patients with task-specific dystonia who fail oral medications or botulinum toxin therapy.
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Affiliation(s)
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, JP
| | - Taku Nonaka
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, JP
| | - Kotaro Kohara
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, JP
| | - Tatsuki Mochizuki
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, JP
| | - Takakzu Kawamata
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, JP
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, JP
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4
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Update in the clinical application of focused ultrasound. Curr Opin Neurol 2022; 35:525-535. [PMID: 35788096 DOI: 10.1097/wco.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the most recent evidence about the clinical applicability of transcranial MRI-guided focused ultrasound (MRgFUS), including clinical evidence and indications, recent technical developments for its use and future prospects. RECENT FINDINGS Unilateral MRgFUS thalamotomy for both essential and parkinsonian tremors is an approved and well established therapy. Recent studies have focused on its long-term safety and efficacy as well as technical advances for refining the approach. Moreover, ultrasound has expanded its application in Parkinson's disease, with clinical trials successfully targeting other brain regions like the subthalamic nucleus, the globus pallidus and the pallidothalamic tract, providing benefits for features that thalamotomy neglects. New indications, such as focal dystonia or neuropsychiatric conditions (namely obsessive-compulsive disorder and depression) have also been explored, with encouraging preliminary results. Finally, the application of ultrasound in low-intensity modality allows other approaches like focal blood-brain barrier opening and neuromodulation, which promise to be highly relevant in translational research. SUMMARY MRgFUS is a growing emergent technique. Its application in clinical routine is becoming widely accepted as a therapeutic option. Novel approaches and new potential applications are anticipated.
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Baumgartner AJ, Thompson JA, Kern DS, Ojemann SG. Novel targets in deep brain stimulation for movement disorders. Neurosurg Rev 2022; 45:2593-2613. [PMID: 35511309 DOI: 10.1007/s10143-022-01770-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/01/2021] [Accepted: 03/08/2022] [Indexed: 12/26/2022]
Abstract
The neurosurgical treatment of movement disorders, primarily via deep brain stimulation (DBS), is a rapidly expanding and evolving field. Although conventional targets including the subthalamic nucleus (STN) and internal segment of the globus pallidus (GPi) for Parkinson's disease and ventral intermediate nucleus of the thalams (VIM) for tremor provide substantial benefit in terms of both motor symptoms and quality of life, other targets for DBS have been explored in an effort to maximize clinical benefit and also avoid undesired adverse effects associated with stimulation. These novel targets primarily include the rostral zona incerta (rZI), caudal zona incerta (cZI)/posterior subthalamic area (PSA), prelemniscal radiation (Raprl), pedunculopontine nucleus (PPN), substantia nigra pars reticulata (SNr), centromedian/parafascicular (CM/PF) nucleus of the thalamus, nucleus basalis of Meynert (NBM), dentato-rubro-thalamic tract (DRTT), dentate nucleus of the cerebellum, external segment of the globus pallidus (GPe), and ventral oralis (VO) complex of the thalamus. However, reports of outcomes utilizing these targets are scattered and disparate. In order to provide a comprehensive resource for researchers and clinicians alike, we have summarized the existing literature surrounding these novel targets, including rationale for their use, neurosurgical techniques where relevant, outcomes and adverse effects of stimulation, and future directions for research.
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Affiliation(s)
| | - John A Thompson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado Hospital, 12631 East 17th Avenue, PO Box 6511, Aurora, CO, 80045, USA
| | - Drew S Kern
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado Hospital, 12631 East 17th Avenue, PO Box 6511, Aurora, CO, 80045, USA
| | - Steven G Ojemann
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
- University of Colorado Hospital, 12631 East 17th Avenue, PO Box 6511, Aurora, CO, 80045, USA.
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Horisawa S, Kohara K, Ebise H, Nishitani M, Kawamata T, Taira T. Efficacy and Safety of Zolpidem for Focal Dystonia After Neurosurgical Treatments: A Retrospective Cohort Study. Front Neurol 2022; 13:837023. [PMID: 35592470 PMCID: PMC9111172 DOI: 10.3389/fneur.2022.837023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
Although there are several reports of the significant efficacy of zolpidem for treating dystonia, zolpidem is still considered an anecdotal treatment. Here, we evaluated the efficacy and safety of zolpidem for treating residual dystonia in patients who previously received various neurosurgical treatments majorly including deep brain stimulation and radiofrequency ablation. We retrospectively reviewed medical records from January 2021 to September 2021 to identify patients with dystonia who had been prescribed zolpidem after undergoing neurosurgery. Twenty patients were enrolled in this study, including those with blepharospasm (two), tongue dystonia (four), mouth dystonia (one), spasmodic dysphonia (two), cervical dystonia (six), focal hand dystonia (three), hemidystonia (two), blepharospasm with cervical dystonia (one), and mouth dystonia with cervical dystonia (one). Single doses of zolpidem ranged between 2.5 and 10 mg, while daily dosages ranged from 10 to 30 mg. The zolpidem dose prescribed was 5–10 mg, with single and daily doses of 7 ± 2.9 and 14.5 ± 6.0 mg, respectively. With zolpidem administration, the participants' Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale score significantly improved from 8.1 ± 6.7 to 3.7 ± 2.5 (50.6% improvement, p < 0.0001). Improvements in arm dystonia, blepharospasm, and spasmodic dysphonia were observed using the Arm Dystonia Disability Scale, Jankovic Rating Scale, and Voice Handicap Index, respectively. No improvements were observed in cervical dystonia on the Toronto Western Spasmodic Torticollis Rating Scale. Drowsiness, including three cases each of mild and moderate drowsiness, was the most frequent adverse effect (30%), which persisted for 2–3 h. Transient amnesia and rapid eye movement sleep behavior disorder occurred in two patients and one patient, respectively. Although our findings suggest that zolpidem can be a valuable treatment option for patients with residual dystonia after neurosurgical treatments, the beneficial effects for cervical dystonia were limited.
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Chang KW, Kim MJ, Park SH, Chang WS, Jung HH, Chang JW. Dual Pallidal and Thalamic Deep Brain Stimulation for Complex Ipsilateral Dystonia. Yonsei Med J 2022; 63:166-172. [PMID: 35083902 PMCID: PMC8819405 DOI: 10.3349/ymj.2022.63.2.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/07/2021] [Accepted: 10/27/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Globus pallidus pars interna (GPi) has become an established target for deep brain stimulation (DBS) in dystonia. Previous studies suggest that targeting the ventralis oralis (Vo) complex nucleus improves dystonic tremor or even focal dystonia. Research has also demonstrated that multi-target DBS shows some benefits over single target DBS. In this study, we reviewed patients who had undergone unilateral DBS targeting the GPi and Vo. MATERIALS AND METHODS Five patients diagnosed with medically refractory upper extremity dystonia (focal or segmental) underwent DBS. Two DBS electrodes each were inserted unilaterally targeting the ipsilateral GPi and Vo. Clinical outcomes were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and Disability Rating Scale. RESULTS BFMDRS scores decreased by 55% at 1-month, 56% at 3-month, 59% at 6-month, and 64% at 12-month follow up. Disability Rating Scale scores decreased 41% at 1-month, 47% at 3-month, 50% at 6-month, and 60% at 12-month follow up. At 1 month after surgery, stimulating both targets improved clinical scores better than targeting GPi or Vo alone. CONCLUSION Unilateral thalamic and pallidal dual electrode DBS may be as effective or even superior to DBS of a single target for dystonia. Although the number of patients was small, our results reflected favorable clinical outcomes.
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Affiliation(s)
- Kyung Won Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Ji Kim
- Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea
| | - So Hee Park
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Won Seok Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Chang
- Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
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Hirao N, Morishita T, Saita K, Takagi T, Fujioka S, Inoue T. Radiofrequency Ventro-oral Thalamotomy for Post-stroke Focal Dystonia in a Pediatric Patient. NMC Case Rep J 2022; 8:445-450. [PMID: 35079502 PMCID: PMC8769475 DOI: 10.2176/nmccrj.cr.2020-0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022] Open
Abstract
Dystonia is a movement disorder that has various treatment options. For primary dystonia, stereotactic procedures such as deep brain stimulation (DBS) have demonstrated favorable outcomes. For secondary dystonia, however, the treatment outcomes remain inconclusive, and the heterogeneous etiological background is considered to contribute to the poor outcomes of the disease. Here, we report a rare pediatric case of post-stroke focal dystonia treated with conventional radiofrequency ventro-oral (Vo) thalamotomy. The patient was an 11-year-old girl with secondary focal dystonia in her right hand. The dystonia was considered to result from a stroke lesion in the putamen due to vasculitis following varicella-zoster virus infection. We hypothesized that the infarction of the putamen resulted in hyperactivity in the thalamus, and, thus, performed a radiofrequency Vo thalamotomy. Markedly decreased muscle tone in her right hand was noted immediately after surgery. However, the improvement was temporary, as her symptoms returned to baseline level by the 6-month follow-up. Although the observed improvement was temporary in this case, our findings may elucidate the possible mechanisms of secondary focal dystonia. Further studies are needed to establish an effective surgical treatment for secondary focal dystonia.
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Affiliation(s)
- Noriko Hirao
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Takashi Morishita
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Kazuya Saita
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Tomohiro Takagi
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Fukuoka University, Fukuoka, Fukuoka, Japan
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Gupta N, Pandey S. Treatment of focal hand dystonia: current status. Neurol Sci 2021; 42:3561-3584. [PMID: 34213695 DOI: 10.1007/s10072-021-05432-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Focal hand dystonia (FHD) is usually adult-onset focal dystonia that can be associated with marked occupational and functional disability leading to reduced quality of life. METHODS Relevant studies on treatment options for FHD, their limitations, and current recommendations were reviewed using the PubMed search until March 31, 2021. Besides, the reference lists of the retrieved publications were manually searched to explore other relevant studies. RESULTS and conclusion Currently, botulinum toxin has the best evidence for treatment of FHD, and 20-90% of patients experience symptomatic improvement. However, its benefit is often limited by the reduction of muscle tonus acting on the muscle spindle. Different surgical modalities that have been used to treat focal hand dystonia include lesional surgery, deep brain stimulation, and magnetic resonance-guided focused ultrasound thalamotomy. Recent studies exploring the role of behavioral techniques, sensorimotor training, and neuromodulation for the treatment of focal hand dystonia have reported good outcomes, but larger studies are required before implementing these interventions in practice.
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Affiliation(s)
- Navnika Gupta
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjay Pandey
- Department of Neurology, Govind Ballabh Pant Postgraduate Institute of Medical Education and Research, New Delhi, 110002, India.
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Morigaki R, Miyamoto R, Matsuda T, Miyake K, Yamamoto N, Takagi Y. Dystonia and Cerebellum: From Bench to Bedside. Life (Basel) 2021; 11:776. [PMID: 34440520 PMCID: PMC8401781 DOI: 10.3390/life11080776] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 12/31/2022] Open
Abstract
Dystonia pathogenesis remains unclear; however, findings from basic and clinical research suggest the importance of the interaction between the basal ganglia and cerebellum. After the discovery of disynaptic pathways between the two, much attention has been paid to the cerebellum. Basic research using various dystonia rodent models and clinical studies in dystonia patients continues to provide new pieces of knowledge regarding the role of the cerebellum in dystonia genesis. Herein, we review basic and clinical articles related to dystonia focusing on the cerebellum, and clarify the current understanding of the role of the cerebellum in dystonia pathogenesis. Given the recent evidence providing new hypotheses regarding dystonia pathogenesis, we discuss how the current evidence answers the unsolved clinical questions.
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Affiliation(s)
- Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (N.Y.); (Y.T.)
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (T.M.); (K.M.)
| | - Ryosuke Miyamoto
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan;
| | - Taku Matsuda
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (T.M.); (K.M.)
| | - Kazuhisa Miyake
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (T.M.); (K.M.)
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (N.Y.); (Y.T.)
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan;
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (N.Y.); (Y.T.)
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima 770-8501, Japan; (T.M.); (K.M.)
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Horisawa S, Yamaguchi T, Abe K, Hori H, Fukui A, Iijima M, Sumi M, Hodotsuka K, Konishi Y, Kawamata T, Taira T. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Focal Hand Dystonia: A Pilot Study. Mov Disord 2021; 36:1955-1959. [PMID: 34050695 PMCID: PMC8453941 DOI: 10.1002/mds.28613] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/06/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background The efficacy of magnetic resonance‐guided focused ultrasound (MRgFUS) thalamotomy for the treatment of focal hand dystonia (FHD) is not well known. Objective We aimed to prospectively investigate the efficacy of MRgFUS thalamotomy for the treatment of FHD. Methods We performed MRgFUS thalamotomy of the ventro‐oral (Vo) nucleus in 10 patients with FHD. We evaluated the scores of the Writer's Cramp Rating Scale (WCRS, 0–30; higher scores indicating greater severity), Tubiana Musician's Dystonia Scale (TMDS, 0–5; lower scores indicating greater severity), and Arm Dystonia Disability Scale (ADDS, 0%–100%; lower scores indicating greater disability) at baseline and 3 and 12 months post‐treatment. Results WCRS, TMDS, and ADDS scores significantly improved from 6.3 ± 2.7, 1.4 ± 0.5, and 58.7% ± 14.3% at baseline to 1.6 ± 3.1 (P = 0.011), 5.0 ± 0 (P = 0.0001), and 81.6% ± 22.9% (P = 0.0229) at 12 months, respectively. There was one prolonged case of dysarthria at 12 months. Conclusion We show that MRgFUS Vo‐thalamotomy significantly improved FHD. © 2021 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshio Yamaguchi
- Department of Radiology, Shinyurigaoka General Hospital, Kanagawa, Japan
| | - Keiichi Abe
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroki Hori
- Department of Radiology, Shinyurigaoka General Hospital, Kanagawa, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Mutsumi Iijima
- Department of Neurology, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Masatake Sumi
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenichi Hodotsuka
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshiyuki Konishi
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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Tsuboi T, Wong JK, Eisinger RS, Okromelidze L, Burns MR, Ramirez-Zamora A, Almeida L, Wagle Shukla A, Foote KD, Okun MS, Grewal SS, Middlebrooks EH. Comparative connectivity correlates of dystonic and essential tremor deep brain stimulation. Brain 2021; 144:1774-1786. [PMID: 33889943 DOI: 10.1093/brain/awab074] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/25/2021] [Accepted: 02/15/2021] [Indexed: 11/14/2022] Open
Abstract
The pathophysiology of dystonic tremor and essential tremor remains partially understood. In patients with medication-refractory dystonic tremor or essential tremor, deep brain stimulation (DBS) targeting the thalamus or posterior subthalamic area has evolved into a promising treatment option. However, the optimal DBS targets for these disorders remains unknown. This retrospective study explored the optimal targets for DBS in essential tremor and dystonic tremor using a combination of volumes of tissue activated estimation and functional and structural connectivity analyses. We included 20 patients with dystonic tremor who underwent unilateral thalamic DBS, along with a matched cohort of 20 patients with essential tremor DBS. Tremor severity was assessed preoperatively and approximately 6 months after DBS implantation using the Fahn-Tolosa-Marin Tremor Rating Scale. The tremor-suppressing effects of DBS were estimated using the percentage improvement in the unilateral tremor-rating scale score contralateral to the side of implantation. The optimal stimulation region, based on the cluster centre of gravity for peak contralateral motor score improvement, for essential tremor was located in the ventral intermediate nucleus region and for dystonic tremor in the ventralis oralis posterior nucleus region along the ventral intermediate nucleus/ventralis oralis posterior nucleus border (4 mm anterior and 3 mm superior to that for essential tremor). Both disorders showed similar functional connectivity patterns: a positive correlation between tremor improvement and involvement of the primary sensorimotor, secondary motor and associative prefrontal regions. Tremor improvement, however, was tightly correlated with the primary sensorimotor regions in essential tremor, whereas in dystonic tremor, the correlation was tighter with the premotor and prefrontal regions. The dentato-rubro-thalamic tract, comprising the decussating and non-decussating fibres, significantly correlated with tremor improvement in both dystonic and essential tremor. In contrast, the pallidothalamic tracts, which primarily project to the ventralis oralis posterior nucleus region, significantly correlated with tremor improvement only in dystonic tremor. Our findings support the hypothesis that the pathophysiology underpinning dystonic tremor involves both the cerebello-thalamo-cortical network and the basal ganglia-thalamo-cortical network. Further our data suggest that the pathophysiology of essential tremor is primarily attributable to the abnormalities within the cerebello-thalamo-cortical network. We conclude that the ventral intermediate nucleus/ventralis oralis posterior nucleus border and ventral intermediate nucleus region may be a reasonable DBS target for patients with medication-refractory dystonic tremor and essential tremor, respectively. Uncovering the pathophysiology of these disorders may in the future aid in further improving DBS outcomes.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Joshua K Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | | | - Mathew R Burns
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | | | - Erik H Middlebrooks
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
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Oh BH, Park YS. Ventralis oralis anterior (Voa) deep brain stimulation plus Gamma Knife thalamotomy in an elderly patient with essential tremor: A case report. Medicine (Baltimore) 2021; 100:e25461. [PMID: 33847653 PMCID: PMC8052051 DOI: 10.1097/md.0000000000025461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/18/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) provides a safe and effective therapy for medically refractory essential tremor (ET). However, DBS may be risky in elderly patients and those with ischemic brain lesions. Gamma Knife radiosurgery (GKS) is a minimally invasive procedure, but bilateral thalamotomy is dangerous. PATIENT CONCERNS We report a case of ventralis oralis anterior nucleus (Voa) DBS for dominant hand tremor plus Voa GKS for nondominant hand tremor in a very elderly patient with medically intractable ET. DIAGNOSIS An 83-year-old right-handed woman visited our hospital with a medically intractable ET. Because of the ischemic lesion in the right basal ganglia, we decided to perform left unilateral DBS instead of bilateral DBS. INTERVENTION We chose Voa as the target for DBS because, clinically, her tremor was mainly confined to her hands, and Voa had better intraoperative microelectrode recording results than Vim. OUTCOMES After 2 years, her right-hand tremor remained in an improved state, but she still had severe tremor in her left hand. Therefore, we performed GKS targeting the right Voa. One year after surgery, the patient's hand tremor successfully improved without any complications. LESSONS Salvage Voa GKS after unilateral Voa DBS is a valuable option for very elderly patients and patients with ischemic brain lesions. We suggest that Voa GKS thalamotomy is as useful and safe a surgical technique as Vim GKS for dystonic hand tremor. To the best of our knowledge, this is the first case report using salvage Voa as the only target for ET.
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Affiliation(s)
- Byeong Ho Oh
- Department of Neuroscience, Graduate School
- Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University
| | - Young Seok Park
- Department of Neuroscience, Graduate School
- Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University
- Department of Neurosurgery, Gamma Knife Icon Center, Chungbuk National University Hospital
- Institute for Stem Cell and Regenerative Medicine (ISCRM), Chungbuk National University, Cheongju, Republic of Korea
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Scerrati A, Labanti S, Lofrese G, Mongardi L, Cavallo MA, Ricciardi L, De Bonis P. Artists playing music while undergoing brain surgery: A look into the scientific evidence and the social media perspective. Clin Neurol Neurosurg 2020; 196:105911. [DOI: 10.1016/j.clineuro.2020.105911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 11/28/2022]
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Tsuboi T, Au KLK, Deeb W, Almeida L, Foote KD, Okun MS, Ramirez-Zamora A. Motor outcomes and adverse effects of deep brain stimulation for dystonic tremor: A systematic review. Parkinsonism Relat Disord 2020; 76:32-41. [PMID: 32559631 DOI: 10.1016/j.parkreldis.2020.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/13/2020] [Accepted: 06/05/2020] [Indexed: 12/22/2022]
Abstract
Dystonic tremor (DT) is defined as the tremor in body parts affected by dystonia. Although deep brain stimulation (DBS) has been used to manage medically-refractory DT patients, its efficacy has not been well established. The objective of this study is to provide an up-to-date systematic review of DBS outcomes for DT patients. We conducted a literature search using Medline, Embase, and Cochrane Library databases in February 2020 according to the PRISMA guidelines. From 858 publications, we identified 30 articles involving 89 DT patients who received DBS of different targets. Thalamic DBS was the most common (n = 39) and improved tremor by 40-50% potentially in the long-term over five years with variable effects on dystonic symptoms. Globus pallidus internus (GPi), subthalamic, and subthalamic nucleus (STN) DBS improved both tremor and dystonic symptoms; however, data were limited. A few studies have reported better tremor and dystonia outcomes with combinations of different targets. Concerning adverse effects, gait/balance disorders, and ataxia seemed to be more common among patients treated with thalamic or subthalamic DBS, whereas parkinsonian adverse effects were observed only in patients treated with subthalamic or GPi DBS. Comparative benefits and limitations of these targets remain unclear because of the lack of randomized controlled trials. In conclusion, DBS of these targets may improve tremor with a variable effect on dystonia with different adverse effect profiles. The shortcomings in the literature include long-term motor outcomes, quality of life outcomes, optimal DBS targeting, and DBS programming strategy.
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Affiliation(s)
- Takashi Tsuboi
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA; Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ka Loong Kelvin Au
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Wissam Deeb
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Leonardo Almeida
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Tripathi M, Sharan S, Mehta S, Deora H, Yagnick NS, Kumar N, Ahuja CK, Batish A, Gurnani J. Gamma Knife Radiosurgical Pallidotomy for Dystonia: Not a Fallen Angel. Neurol India 2020; 67:1515-1518. [PMID: 31857549 DOI: 10.4103/0028-3886.273644] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The authors report a case of successful management of right side hemidystonia with gamma knife radiosurgery. A 24-year-old male with a history of birth asphyxia subsequently developed worsening right-sided torsional hemidystonia which failed to respond to the medical management. MRI of the brain was unremarkable. Stereotactic gamma knife radiosurgery (GKRS) was performed to create a lesion in the left posteroventral globus pallidum. The patient gradually improved over a course of 18 months without any complication. He obtained 61% improvement in dystonia rating scale. Radiosurgical pallidotomy is often viewed with suspicion and functional neurosurgeons show reluctance in preferring it to stereotactic radio frequency lesioning or stimulation surgery. The authors would like to highlight the chances of not only control, but also cure of the disease with this cost-effective treatment modality.
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Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Srinivasan Sharan
- Jain Institute of Movement Disorders and Stereotactic Neurosurgery, Bangalore, Karnataka, India
| | - Sahil Mehta
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute of Medical Health and Neurosciences, Bangalore, Karnataka, India
| | - Nishant S Yagnick
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag K Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Batish
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jenil Gurnani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Affiliation(s)
- Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Abstract
The dystonias are a large and heterogenous group of disorders characterized by excessive muscle contractions leading to abnormal postures and/or repetitive movements. Their clinical manifestations vary widely, and there are many potential causes. Despite the heterogeneity, helpful treatments are available for the vast majority of patients. Symptom-based therapies include oral medications, botulinum toxins, and surgical interventions. For some subtypes of dystonia, specific mechanism-based treatments are available. Advances in understanding the biological basis for many types of dystonia have led to numerous recent clinical trials, so additional treatments are likely to become available in the very near future.
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19
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Bellows S, Jankovic J. Treatment of dystonia and tics. Clin Park Relat Disord 2019; 2:12-19. [PMID: 34316614 PMCID: PMC8302199 DOI: 10.1016/j.prdoa.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 11/30/2022] Open
Abstract
Treatment of dystonia and tics continues to evolve. In dystonia, while oral agents such as benzodiazepines, baclofen and anticholinergics remain in use, botulinum toxin (BoNT) continues to be regarded as the treatment of choice for focal and segmental dystonia, but new preparations are being studied. While deep brain stimulation (DBS) has typically focused on targeting the globus pallidus internus (GPi) when treating dystonia, more recent research has expanded the targets to include subthalamic nucleus (STN) and other targets. In addition to DBS, thalamotomies continue to show therapeutic benefit in focal hand dystonias. Treatment of tics includes a growing armamentarium of options besides the three FDA-approved drugs, all dopamine receptor blockers (haloperidol, pimozide and aripiprazole). Because of lower risk of adverse effects, dopamine depleters (e.g. tetrabebazine, deutetrabenazine, and valbenazine), along with novel D1 receptor antagonists, are currently studied as treatment alternatives in patients with tics. Practice guidelines for the treatment of tics and Tourette syndrome have been recently updated. Data regarding the use of DBS in treatment of tics remains relatively sparse, but international registries have expanded our understanding of the effect of stimulation at several targets.
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Affiliation(s)
- Steven Bellows
- Parkinson's Disease Center, Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, United States of America
| | - Joseph Jankovic
- Parkinson's Disease Center, Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, United States of America
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20
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Horisawa S, Yamaguchi T, Abe K, Hori H, Sumi M, Konishi Y, Taira T. A single case of MRI-guided focused ultrasound ventro-oral thalamotomy for musician's dystonia. J Neurosurg 2019; 131:384-386. [PMID: 30239322 DOI: 10.3171/2018.5.jns173125] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/10/2018] [Indexed: 11/06/2022]
Abstract
Musician's dystonia (MD) is a type of focal hand dystonia that develops only while playing musical instruments and interferes with skilled and fine movements. Lesioning of the ventro-oral (Vo) nucleus of the thalamus (Vo-thalamotomy) using radiofrequency can cause dramatic improvement in MD symptoms. Focused ultrasound (FUS) can make intracranial focal lesions without an incision. The authors used MRI-guided FUS (MRgFUS) to create a lesion on the Vo nucleus to treat a patient with MD. Tubiana's MD scale (TMDS) was used to evaluate the condition of musical play ranging from 1 to 5 (1: worst, 5: best). The patient was a 35-year-old right-handed man with involuntary flexion of the right second, third, and fourth fingers, which occurred while playing a classical guitar. Immediately after therapeutic sonications of FUS Vo-thalamotomy, there was dramatic improvement in the MD symptoms. The TMDS scores before; at 0 and 1 week after; and at 1, 3, 6, and 12 months after MRgFUS Vo-thalamotomy were 1, 4, 4, 5, 5, 5, and 5, respectively. No complications were observed. Focused ultrasound Vo-thalamotomy can be an effective treatment for MD.
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Affiliation(s)
- Shiro Horisawa
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Toshio Yamaguchi
- 2Department of Radiology, Shin-Yurigaoka General Hospital, Kawasaki; and
| | - Keiichi Abe
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Hiroki Hori
- 3Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Masatake Sumi
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Yoshiyuki Konishi
- 3Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering & Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Takaomi Taira
- 1Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
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21
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Park JE, Shamim EA, Panyakaew P, Mathew P, Toro C, Sackett J, Karp B, Lungu C, Alter K, Wu T, Ahmad OF, Villegas M, Auh S, Hallett M. Botulinum toxin and occupational therapy for Writer's cramp. Toxicon 2019; 169:12-17. [PMID: 31351085 DOI: 10.1016/j.toxicon.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/20/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Writer's cramp (WC) is a form of focal hand dystonia, for which focal botulinum neurotoxin (BoNT) injections are the current best therapy. Past studies have shown that some types of rehabilitative therapy can be useful. We hypothesized that BoNT together with a specific type of occupational therapy would be better than BoNT alone for treating WC patients comparing the effects with a patient-rated subjective scale. METHODS Twelve WC patients were randomized to two groups. Six received only BoNT therapy and 6 received BoNT & occupational therapy. The occupational therapy involved specific exercises of finger movements in the direction opposite to the dystonic movements during writing. BoNT was injected by movement disorders neurologists in the affected muscles under electromyography-guidance. The primary outcome was the patient-rated subjective scale at 20 weeks. Secondary exploratory outcomes included the writer's cramp rating scale (WCRS), writer's cramp impairment scale (WCIS), the writer's cramp disability scale (WCDS), handgrip strength and kinetic parameters. RESULTS The patient-rated subjective scale scores at 20 weeks were not significantly different between the two groups. Significant objective improvement was noted in the BoNT & occupational therapy group, as noted by the decrease (28%) in WCIS scores. CONCLUSIONS Improvement of the primary outcome measure, the patient-rated subjective scale, was not achieved. However, significant improvement was found in the BoNT & occupational therapy group in a secondary measure of impairment. Our hypothesis-driven study results are likely limited by small sample size, and further large-scale studies of occupational therapy methods to improve the efficacy of BoNT seems worthwhile.
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Affiliation(s)
- Jung E Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea; Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ejaz A Shamim
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Pattamon Panyakaew
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence on Parkinson Disease and Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pawan Mathew
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Camilo Toro
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jonathan Sackett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Barbara Karp
- Combined Neuroscience Institutional Review Board, Office of the Clinical Director, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Rockville, MD, USA
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Tianxia Wu
- Clinical Neuroscience Program, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Omar F Ahmad
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA; Mount Carmel Neurology, Westerville, OH, USA
| | - Monica Villegas
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Sungyoung Auh
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
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Asahi T, Taira T, Ikeda K, Horisawa S, Yamamoto J, Tsubono H, Sato S. Improvement of Writer's Cramp from an Old Lesion in the Contralateral Hemisphere with Transient Gait Disturbance After Thalamotomy. World Neurosurg 2019; 127:8-10. [PMID: 30928593 DOI: 10.1016/j.wneu.2019.03.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Stereotactic ventro-oral thalamotomy has been performed in cases of focal task-specific dystonia, including writer's cramp, with excellent outcomes. However, no reports have revealed the outcome of ventro-oral thalamotomy in a patient with a contralateral cerebral lesion. We describe a patient with left-hand writer's cramp with an old lesion in the left hemisphere and transient gait disturbance after right ventro-oral thalamotomy. CASE DESCRIPTION A 43-year-old man had a hemorrhage in the left basal ganglia due to cerebral arteriovenous malformation at 22 years of age, and right hemiparesis remained as a sequela. He developed left-handed writing ability; however, he became aware of the stiffness of his left hand and difficulty in writing. Writer's cramp was diagnosed. Medical treatments were not effective, and right ventro-oral thalamotomy was performed. Although his writing ability improved, he could not walk. After performing rehabilitation, his walking completely improved, reaching the level before surgery, after 3 months, and his writer's cramp was completely cured. CONCLUSIONS In patients with basal nucleus lesions, gait disturbance may appear transiently after contralateral thalamotomy. It is crucial to fully explain the potential complications, particularly in relation to temporal gait disturbances, and obtain informed consent.
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Affiliation(s)
- Takashi Asahi
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan.
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Hospital, Tokyo, Japan
| | - Kiyonobu Ikeda
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Hospital, Tokyo, Japan
| | - Jiro Yamamoto
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsubono
- Department of Medical Engineering, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
| | - Shuji Sato
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Kanazawa, Ishikawa, Japan
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Horisawa S, Ochiai T, Goto S, Nakajima T, Takeda N, Fukui A, Hanada T, Kawamata T, Taira T. Safety and long-term efficacy of ventro-oral thalamotomy for focal hand dystonia: A retrospective study of 171 patients. Neurology 2018; 92:e371-e377. [PMID: 30587520 PMCID: PMC6345121 DOI: 10.1212/wnl.0000000000006818] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To report the safety and long-term efficacy of ventro-oral thalamotomy for 171 consecutive patients with task-specific focal hand dystonia. Methods Between October 2003 and February 2017, 171 consecutive patients with task-specific focal hand dystonia underwent unilateral ventro-oral thalamotomy. Etiologies included writer's cramps (n = 92), musician's dystonias (n = 58), and other occupational task-related dystonias (n = 21). The task-specific focal hand dystonia scale was used to evaluate patients' neurologic conditions (range 1–5, high score indicated a better condition). The scores before surgery; at 1 week, 3 months, and 12 months postoperatively; and the last available follow-up period were determined. Postoperative complications and postoperative recurrence were also evaluated. Results The scores before surgery; at 1 week (1.72 ± 0.57, 4.33 ± 0.85 [p < 0.001]), 3 months (4.30 ± 1.06 [p < 0.001]), and 12 months (4.30 ± 1.13 [p < 0.001]); and the last available follow-up (4.39 ± 1.07 [p < 0.001]) postoperatively improved. The mean clinical follow-up period was 25.4 ± 32.1 months (range: 3–165). Permanent adverse events developed in 6 patients (3.5%). Eighteen patients developed recurrent dystonic symptoms postoperatively. Of these 18 patients, 9 underwent ventro-oral thalamotomy again, of which 7 achieved improvement. Conclusion Ventro-oral thalamotomy is a feasible and reasonable treatment for patients with refractory task-specific focal hand dystonias. Prospective, randomized, and blinded studies are warranted to clarify more accurate assessment of the safety and efficacy of ventro-oral thalamotomy for task-specific focal hand dystonia. Classification of evidence This study provides Class IV evidence that for patients with task-specific focal hand dystonia, ventro-oral thalamotomy improves dystonia.
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Affiliation(s)
- Shiro Horisawa
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Taku Ochiai
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Shinichi Goto
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takeshi Nakajima
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Nobuhiko Takeda
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Atsushi Fukui
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Tomoko Hanada
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takakazu Kawamata
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan
| | - Takaomi Taira
- From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan.
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24
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Shimizu T, Maruo T, Miura S, Kishima H, Ushio Y, Goto S. Stereotactic Lesioning of the Thalamic Vo Nucleus for the Treatment of Writer's Cramp (Focal Hand Dystonia). Front Neurol 2018; 9:1008. [PMID: 30534112 PMCID: PMC6275197 DOI: 10.3389/fneur.2018.01008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/07/2018] [Indexed: 12/11/2022] Open
Abstract
Writer's cramp (focal hand dystonia) is a sporadic focal dystonia that affects a specific part of the upper limb causing excessive co-contraction of antagonistic muscles. It usually presents as a task-specific dystonia, including, among others, writing of a character or playing a musical instrument. Although treatments for writer's cramp exist, medical therapy often results in unsatisfactory outcomes in patients with this type of dystonia. However, accumulating evidence suggests that long-term and complete remission of various types of focal hand dystonia can be achieved with stereotactic ablation or deep brain stimulation of the thalamic ventral-oralis complex (Vo) nucleus, which includes both the ventralis oralis posterior and anterior nuclei of the thalamus. Following the striking therapeutic success of Vo thalamotomy in patients with medically-refractory writer's cramp, we here introduce the use of stereotactic lesioning of the thalamic Vo nucleus for the treatment of this focal type of dystonia. Our findings identified patients with disabling writer's cramp (i.e., it prevents their success in their professional careers) to be good candidates for positive outcome with this surgical technique.
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Affiliation(s)
- Takeshi Shimizu
- Department of Neurosurgery, Parkinson's Disease Research Center, KKR Otemae Hospital, Osaka, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoyuki Maruo
- Department of Neurosurgery, Parkinson's Disease Research Center, KKR Otemae Hospital, Osaka, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shimpei Miura
- Department of Neurosurgery, Parkinson's Disease Research Center, KKR Otemae Hospital, Osaka, Japan.,Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yukitaka Ushio
- Department of Neurosurgery, Parkinson's Disease Research Center, KKR Otemae Hospital, Osaka, Japan
| | - Satoshi Goto
- Department of Neurodegenerative Disorders Research, Graduate School of Medical Sciences, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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25
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Abstract
Dystonia is a neurological condition characterized by abnormal involuntary movements or postures owing to sustained or intermittent muscle contractions. Dystonia can be the manifesting neurological sign of many disorders, either in isolation (isolated dystonia) or with additional signs (combined dystonia). The main focus of this Primer is forms of isolated dystonia of idiopathic or genetic aetiology. These disorders differ in manifestations and severity but can affect all age groups and lead to substantial disability and impaired quality of life. The discovery of genes underlying the mendelian forms of isolated or combined dystonia has led to a better understanding of its pathophysiology. In some of the most common genetic dystonias, such as those caused by TOR1A, THAP1, GCH1 and KMT2B mutations, and idiopathic dystonia, these mechanisms include abnormalities in transcriptional regulation, striatal dopaminergic signalling and synaptic plasticity and a loss of inhibition at neuronal circuits. The diagnosis of dystonia is largely based on clinical signs, and the diagnosis and aetiological definition of this disorder remain a challenge. Effective symptomatic treatments with pharmacological therapy (anticholinergics), intramuscular botulinum toxin injection and deep brain stimulation are available; however, future research will hopefully lead to reliable biomarkers, better treatments and cure of this disorder.
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26
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Abstract
Within the field of movement disorders, the conceptual understanding of dystonia has continued to evolve. Clinical advances have included improvements in recognition of certain features of dystonia, such as tremor, and understanding of phenotypic spectrums in the genetic dystonias and dystonia terminology and classification. Progress has also been made in the understanding of underlying biological processes which characterize dystonia from discoveries using approaches such as neurophysiology, functional imaging, genetics, and animal models. Important advances include the role of the cerebellum in dystonia, the concept of dystonia as an aberrant brain network disorder, additional evidence supporting the concept of dystonia endophenotypes, and new insights into psychogenic dystonia. These discoveries have begun to shape treatment approaches as, in parallel, important new treatment modalities, including magnetic resonance imaging-guided focused ultrasound, have emerged and existing interventions such as deep brain stimulation have been further refined. In this review, these topics are explored and discussed.
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Affiliation(s)
- Stephen Tisch
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurology, St Vincent's Hospital, Sydney, Australia
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27
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Yokochi F, Kato K, Iwamuro H, Kamiyama T, Kimura K, Yugeta A, Okiyama R, Taniguchi M, Kumada S, Ushiba J. Resting-State Pallidal-Cortical Oscillatory Couplings in Patients With Predominant Phasic and Tonic Dystonia. Front Neurol 2018; 9:375. [PMID: 29904367 PMCID: PMC5990626 DOI: 10.3389/fneur.2018.00375] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/08/2018] [Indexed: 11/13/2022] Open
Abstract
Pallidal deep brain stimulation (DBS) improves the symptoms of dystonia. The improvement processes of dystonic movements (phasic symptoms) and tonic symptoms differ. Phasic symptoms improve rapidly after starting DBS treatment, but tonic symptoms improve gradually. This difference implies distinct neuronal mechanisms for phasic and tonic symptoms in the underlying cortico-basal ganglia neuronal network. Phasic symptoms are related to the pallido-thalamo-cortical pathway. The pathway related to tonic symptoms has been assumed to be different from that for phasic symptoms. In the present study, local field potentials of the globus pallidus internus (GPi) and globus pallidus externus (GPe) and electroencephalograms from the motor cortex (MCx) were recorded in 19 dystonia patients to analyze the differences between the two types of symptoms. The 19 patients were divided into two groups, 10 with predominant phasic symptoms (phasic patients) and 9 with predominant tonic symptoms (tonic patients). To investigate the distinct features of oscillations and functional couplings across the GPi, GPe, and MCx by clinical phenotype, power and coherence were calculated over the delta (2-4 Hz), theta (5-7 Hz), alpha (8-13 Hz), and beta (14-35 Hz) frequencies. In phasic patients, the alpha spectral peaks emerged in the GPi oscillatory activities, and alpha GPi coherence with the GPe and MCx was higher than in tonic patients. On the other hand, delta GPi oscillatory activities were prominent, and delta GPi-GPe coherence was significantly higher in tonic than in phasic patients. However, there was no significant delta coherence between the GPi/GPe and MCx in tonic patients. These results suggest that different pathophysiological cortico-pallidal oscillations are related to tonic and phasic symptoms.
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Affiliation(s)
- Fusako Yokochi
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Kenji Kato
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.,Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Hirokazu Iwamuro
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Tsutomu Kamiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Katsuo Kimura
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Akihiro Yugeta
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Ryoichi Okiyama
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Makoto Taniguchi
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Satoko Kumada
- Department of Pediatric Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Junichi Ushiba
- Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, Kanagawa, Japan
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28
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Asahi T, Taira T, Ikeda K, Yamamoto J, Sato S. Full recovery from drummer's dystonia with foot and arm symptoms after stereotactic ventro-oral thalamotomy: a case report. Acta Neurochir (Wien) 2018; 160:835-838. [PMID: 29423776 DOI: 10.1007/s00701-018-3480-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/25/2018] [Indexed: 10/18/2022]
Abstract
Ventro-oral (Vo) thalamotomy is effective in patients with focal task-specific dystonias (FTSDs), but only in those with upper-limb symptoms. We describe a patient with drummer's dystonia who completely recovered after Vo thalamotomy. A 37-year-old man who started playing drums at 14 began having difficulty performing fine movements with his right foot when drumming at 22. He experienced right hand cramps while drumming 3 months before visiting our hospital. He was diagnosed with FTSD. Left Vo thalamotomy was performed, which led to complete improvement of symptoms. Vo thalamotomy may be effective for FTSD patients with upper- and lower-extremity symptoms.
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29
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Sadnicka A, Kornysheva K, Rothwell JC, Edwards MJ. A unifying motor control framework for task-specific dystonia. Nat Rev Neurol 2018; 14:116-124. [PMID: 29104291 PMCID: PMC5975945 DOI: 10.1038/nrneurol.2017.146] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Task-specific dystonia is a movement disorder characterized by a painless loss of dexterity specific to a particular motor skill. This disorder is prevalent among writers, musicians, dancers and athletes. No current treatment is predictably effective, and the disorder generally ends the careers of affected individuals. Traditional disease models of dystonia have a number of limitations with regard to task-specific dystonia. We therefore discuss emerging evidence that the disorder has its origins within normal compensatory mechanisms of a healthy motor system in which the representation and reproduction of motor skill are disrupted. We describe how risk factors for task-specific dystonia can be stratified and translated into mechanisms of dysfunctional motor control. The proposed model aims to define new directions for experimental research and stimulate therapeutic advances for this highly disabling disorder.
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Affiliation(s)
- Anna Sadnicka
- Sobell Department for Motor Neuroscience, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK, and the Motor Control and movement Disorders Group, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
| | - Katja Kornysheva
- School of Psychology, Bangor University, Adeilad Brigantia, Penrallt Road, Gwynedd LL57 2AS, Wales, UK, and the Institute of Cognitive Neuroscience, University College London, 17 Queen Square, London WC1N 3AZ, UK
| | - John C Rothwell
- Sobell Department for Motor Neuroscience, Institute of Neurology, University College London, 33 Queen Square, London WC1N 3BG, UK
| | - Mark J Edwards
- Motor Control and Movement Disorders Group, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK
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30
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Horisawa S, Kohara K, Kawamata T, Taira T. Successful treatment of task-specific lower extremity dystonia by ventro-oral thalamotomy. Mov Disord 2017; 33:338-339. [DOI: 10.1002/mds.27180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Neurological Institute; Tokyo Women's Medical University; Tokyo Japan
| | - Kotaro Kohara
- Department of Neurosurgery, Neurological Institute; Tokyo Women's Medical University; Tokyo Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute; Tokyo Women's Medical University; Tokyo Japan
| | - Takaomi Taira
- Department of Neurosurgery, Neurological Institute; Tokyo Women's Medical University; Tokyo Japan
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31
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Horisawa S, Sumi M, Akagawa H, Kawamata T, Taira T. Thalamotomy for paroxysmal kinesigenic dyskinesias in a multiplex family. Eur J Neurol 2017; 24:e71-e72. [DOI: 10.1111/ene.13379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 06/27/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. Horisawa
- Department of Neurosurgery Neurological Institute Tokyo Women's Medical University Tokyo Japan
| | - M. Sumi
- Department of Neurosurgery Neurological Institute Tokyo Women's Medical University Tokyo Japan
| | - H. Akagawa
- Tokyo Women's Medical University Institute for Integrated Medical Sciences Tokyo Japan
| | - T. Kawamata
- Department of Neurosurgery Neurological Institute Tokyo Women's Medical University Tokyo Japan
| | - T. Taira
- Department of Neurosurgery Neurological Institute Tokyo Women's Medical University Tokyo Japan
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32
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Tewari A, Fremont R, Khodakhah K. It's not just the basal ganglia: Cerebellum as a target for dystonia therapeutics. Mov Disord 2017; 32:1537-1545. [PMID: 28843013 DOI: 10.1002/mds.27123] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/01/2023] Open
Abstract
Dystonia is a common movement disorder that devastates the lives of many patients, but the etiology of this disorder remains poorly understood. Dystonia has traditionally been considered a disorder of the basal ganglia. However, growing evidence suggests that the cerebellum may be involved in certain types of dystonia, raising several questions. Can different types of dystonia be classified as either a basal ganglia disorder or a cerebellar disorder? Is dystonia a network disorder that involves the cerebellum and basal ganglia? If dystonia is a network disorder, how can we target treatments to alleviate symptoms in patients? A recent study by Chen et al, using the pharmacological mouse model of rapid-onset dystonia parkinsonism, has provided some insight into these important questions. They showed that the cerebellum can directly modulate basal ganglia activity through a short latency cerebello-thalamo-basal ganglia pathway. Further, this article and others have provided evidence that in some cases, aberrant cerebello-basal ganglia communication can be involved in dystonia. In this review we examine the evidence for the involvement of the cerebellum and cerebello-basal ganglia interactions in dystonia. We conclude that there is ample evidence to suggest that the cerebellum plays a role in some dystonias, including the early-onset primary torsion dystonia DYT1 and that further studies examining the role of this brain region and its interaction with the basal ganglia in dystonia are warranted. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ambika Tewari
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Fremont
- Columbia University Medical Center, Department of Psychiatry, New York, New York, USA
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
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33
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Kobayashi S, Morita A. The History of Neuroscience and Neurosurgery in Japan. ACTA ACUST UNITED AC 2017. [DOI: 10.17795/inj867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Shigeaki Kobayashi
- Medical Research and Education Center, Stroke and Brain Center, Aizawa Hospital, Matsumoto , Japan
| | - Akio Morita
- Medical Research and Education Center, Stroke and Brain Center, Aizawa Hospital, Matsumoto , Japan
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34
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Pirio Richardson S, Altenmüller E, Alter K, Alterman RL, Chen R, Frucht S, Furuya S, Jankovic J, Jinnah HA, Kimberley TJ, Lungu C, Perlmutter JS, Prudente CN, Hallett M. Research Priorities in Limb and Task-Specific Dystonias. Front Neurol 2017; 8:170. [PMID: 28515706 PMCID: PMC5413505 DOI: 10.3389/fneur.2017.00170] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/11/2017] [Indexed: 11/13/2022] Open
Abstract
Dystonia, which causes intermittent or sustained abnormal postures and movements, can present in a focal or a generalized manner. In the limbs, focal dystonia can occur in either the upper or lower limbs and may be task-specific causing abnormal motor performance for only a specific task, such as in writer’s cramp, runner’s dystonia, or musician’s dystonia. Focal limb dystonia can be non-task-specific and may, in some circumstances, be associated with parkinsonian disorders. The true prevalence of focal limb dystonia is not known and is likely currently underestimated, leaving a knowledge gap and an opportunity for future research. The pathophysiology of focal limb dystonia shares some commonalities with other dystonias with a loss of inhibition in the central nervous system and a loss of the normal regulation of plasticity, called homeostatic plasticity. Functional imaging studies revealed abnormalities in several anatomical networks that involve the cortex, basal ganglia, and cerebellum. Further studies should focus on distinguishing cause from effect in both physiology and imaging studies to permit focus on most relevant biological correlates of dystonia. There is no specific therapy for the treatment of limb dystonia given the variability in presentation, but off-label botulinum toxin therapy is often applied to focal limb and task-specific dystonia. Various rehabilitation techniques have been applied and rehabilitation interventions may improve outcomes, but small sample size and lack of direct comparisons between methods to evaluate comparative efficacy limit conclusions. Finally, non-invasive and invasive therapeutic modalities have been explored in small studies with design limitations that do not yet clearly provide direction for larger clinical trials that could support new clinical therapies. Given these gaps in our clinical, pathophysiologic, and therapeutic knowledge, we have identified priorities for future research including: the development of diagnostic criteria for limb dystonia, more precise phenotypic characterization and innovative clinical trial design that considers clinical heterogeneity, and limited available number of participants.
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Affiliation(s)
- Sarah Pirio Richardson
- Department of Neurology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians' Medicine (IMMM), Hannover University of Music, Drama and Media, Hannover, Germany
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine, National Institute of Child Health and Development, National Institutes of Health, Bethesda, MD, USA
| | - Ron L Alterman
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert Chen
- Division of Neurology, Department of Medicine (Neurology), Krembil Research Institute, University of Toronto, Toronto, ON, Canada
| | - Steven Frucht
- Robert and John M. Bendheim Parkinson and Movement Disorders Center, Mount Sinai Hospital, New York, NY, USA
| | - Shinichi Furuya
- Musical Skill and Injury Center (MuSIC), Sophia University, Tokyo, Japan
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - H A Jinnah
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.,Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Teresa J Kimberley
- Department of Rehabilitation Medicine, Division of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Codrin Lungu
- Division of Clinical Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Joel S Perlmutter
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Neurosciences, Washington University School of Medicine, St. Louis, MO, USA.,Department of Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA.,Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Cecília N Prudente
- Department of Rehabilitation Medicine, Division of Physical Therapy and Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
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35
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Improvement of Table Tennis Dystonia by Stereotactic Ventro-Oral Thalamotomy: A Case Report. World Neurosurg 2017; 99:810.e1-810.e4. [PMID: 28063895 DOI: 10.1016/j.wneu.2016.12.117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Task-specific focal dystonia, such as writer's cramp and musician's cramp, is a type of dystonia that affects performance of particular tasks. Such movement disorders have been treated with stereotactic ventro-oral (Vo) thalamotomy with excellent outcomes. However, there has been no previous report of treatment of sport-related or athlete's dystonia by means of stereotactic surgery. We treated a patient with table tennis-related dystonia with Vo thalamotomy, and evaluated the outcome. CASE DESCRIPTION A 20-year-old, female, left-handed table tennis player complained of difficulty hitting a ping-pong ball. She started playing table tennis at 8 years of age, practiced for more than 4 hours every day, and participated in national tournaments. Abnormal flexion of the left wrist when hitting a ball became apparent when she was 19 years old. The abnormal movement emerged on the forehand stroke and, subsequently, on the backhand, until finally she could not continue playing. The diagnosis was task-specific focal dystonia that did not recover with medication. She visited our hospital and underwent right Vo thalamotomy. The surgery was performed using local anesthesia, with the patient swinging a paddle during stimulation and coagulation of the thalamus. Her symptoms had improved completely the day after surgery, such that she was able to participate in tournaments again. CONCLUSIONS We applied Vo thalamotomy for the successful treatment of athlete's dystonia, suggesting that this condition has an underlying mechanism similar to that of other task-specific focal dystonias. This provides new hope to patients with athlete's dystonia refractive to other therapies.
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36
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Focal task specific dystonia: a review and update. J Neurol 2016; 264:1536-1541. [PMID: 28039522 PMCID: PMC5502053 DOI: 10.1007/s00415-016-8373-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 11/15/2022]
Abstract
In this review, we summarize recent advances in understanding the etiology, risk factors and pathophysiology of focal task specific dystonia (FTSD), movement disorders characterized by abnormal motor activation during the performance of specific, repetitive actions. We focus on two common FTSD, musician’s dystonia and writer’s cramp. FTSD may pose a threat to the patient’s livelihood, and improved therapeutic treatments are needed.
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37
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Bilateral Stereotactic Thalamotomy for Bilateral Musician's Hand Dystonia. World Neurosurg 2016; 92:585.e21-585.e25. [DOI: 10.1016/j.wneu.2016.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022]
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38
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Horisawa S, Goto S, Nakajima T, Ochiai T, Kawamata T, Taira T. Stereotactic Thalamotomy for Hairdresser's Dystonia: A Case Series. Stereotact Funct Neurosurg 2016; 94:201-206. [PMID: 27434121 DOI: 10.1159/000446612] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hairdresser's dystonia is a rarely reported form of focal hand dystonia, and the clinical course and treatment remains poorly understood. OBJECTIVES The aim of this report was to clarify the impact of thalamotomy on hairdresser's dystonia. METHODS Four consecutive patients with hairdresser's task-specific dystonia evaluated at Tokyo Women's Medical University Hospital between 2008 and 2013 were treated with stereotactic thalamotomy, and were recruited for this case series. RESULTS The mean age at the onset of symptoms was 37.25 ± 10.64 years, the median duration of symptoms was 4.25 ± 1.3 years, and the mean follow-up period was 17 ± 12.37 months. Two of the 4 patients returned to work with significant improvement following the stereotactic thalamotomy and the beneficial effects persisted for the duration of their clinical follow-up. The other 2 patients experienced transient improvements for up to 3 months. Surgical complications included only dysarthria in 2 patients, and did not interfere with their daily activities. No patients experienced a deterioration of dystonic symptoms after thalamotomy. CONCLUSION Although the benefits of thalamotomy remain vulnerable to incorrect or insufficient coagulation, stereotactic thalamotomy may be a feasible and effective procedure for patients with hairdresser's dystonia.
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Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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39
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Horisawa S, Tamura N, Hayashi M, Matsuoka A, Hanada T, Kawamata T, Taira T. Gamma Knife Ventro-Oral Thalamotomy for Musician's Dystonia. Mov Disord 2016; 32:89-90. [PMID: 27431379 DOI: 10.1002/mds.26726] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/08/2016] [Accepted: 06/15/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Noriko Tamura
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Motohiro Hayashi
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Ayako Matsuoka
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Tomoko Hanada
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
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Horisawa S, Takeda N, Taira T. Watchmaker's Dystonia. Mov Disord Clin Pract 2015; 3:102-103. [PMID: 30713904 DOI: 10.1002/mdc3.12236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/21/2015] [Accepted: 06/30/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery Tokyo Women's Medical University Tokyo Japan
| | - Nobuhiko Takeda
- Department of Neurosurgery Tokyo Women's Medical University Tokyo Japan
| | - Takaomi Taira
- Department of Neurosurgery Tokyo Women's Medical University Tokyo Japan
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Furuya S, Altenmüller E. Acquisition and reacquisition of motor coordination in musicians. Ann N Y Acad Sci 2015; 1337:118-24. [PMID: 25773625 DOI: 10.1111/nyas.12659] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Precise control of movement timing plays a key role in musical performance. This motor skill requires coordination across multiple joints and muscles, which is acquired through extensive musical training from childhood. However, extensive training has a potential risk of causing neurological disorders that impair fine motor control, such as task-specific tremor and focal dystonia. Recent technological advances in measurement and analysis of biological data, as well as noninvasive manipulation of neuronal activities, have promoted the understanding of computational and neurophysiological mechanisms underlying acquisition, loss, and reacquisition of dexterous movements through musical practice and rehabilitation. This paper aims to provide an overview of the behavioral and neurophysiological basis of motor virtuosity and disorder in musicians, representative extremes of human motor skill. We also report novel evidence of effects of noninvasive neurorehabilitation that combined transcranial direct-current stimulation and motor rehabilitation over multiple days on musician's dystonia, which offers a promising therapeutic means.
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Affiliation(s)
- Shinichi Furuya
- Institute for Music Physiology and Musicians' Medicine, Hanover University of Music, Drama and Media, Hanover, Germany; Department of Information and Communication Sciences, Sophia University, Tokyo, Japan
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Abstract
Musician's dystonia is a task-specific dystonia that usually affects the embouchure or the most active digits of the most active hand, and therefore differs between instruments. Since it is usually painless and intermittent, the diagnosis is often delayed and it is commonly misdiagnosed as being an overuse disorder or tendon pathology. It arises from pathological brain plasticity: physiological studies suggest that it is an exaggeration of brain changes that are required to achieve advanced musical skills. Its treatment often has limited success; however, musical retraining, botulinum toxin or rehabilitation based on modifying the aberrant plasticity may help.
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Dystonia and cerebellar degeneration in the leaner mouse mutant. Brain Res 2015; 1611:56-64. [PMID: 25791619 DOI: 10.1016/j.brainres.2015.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 03/06/2015] [Indexed: 01/18/2023]
Abstract
Cerebellar degeneration is traditionally associated with ataxia. Yet, there are examples of both ataxia and dystonia occurring in individuals with cerebellar degeneration. There is also substantial evidence suggesting that cerebellar dysfunction alone may cause dystonia. The types of cerebellar defects that may cause ataxia, dystonia, or both have not been delineated. In the current study, we explored the relationship between cerebellar degeneration and dystonia using the leaner mouse mutant. Leaner mice have severe dystonia that is associated with dysfunctional and degenerating cerebellar Purkinje cells. Whereas the density of Purkinje cells was not significantly reduced in 4 week-old leaner mice, approximately 50% of the neurons was lost by 34 weeks of age. On the other hand, the dystonia and associated functional disability became significantly less severe during this same interval. In other words, dystonia improved as Purkinje cells were lost, suggesting that dysfunctional Purkinje cells, rather than Purkinje cell loss, contribute to the dystonia. These results provide evidence that distorted cerebellar function may cause dystonia and support the concept that different types of cerebellar defects can have different functional consequences.
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Short latency cerebellar modulation of the basal ganglia. Nat Neurosci 2014; 17:1767-75. [PMID: 25402853 PMCID: PMC4241171 DOI: 10.1038/nn.3868] [Citation(s) in RCA: 197] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/14/2014] [Indexed: 12/13/2022]
Abstract
The graceful, purposeful motion of our body is an engineering feat which remains unparalleled in robotic devices using advanced artificial intelligence. Much of the information required for complex movements is generated by the cerebellum and the basal ganglia in conjunction with the cortex. Cerebellum and basal ganglia have been thought to communicate with each other only through slow multi-synaptic cortical loops, begging the question as to how they coordinate their outputs in real time. Here we show in mice that the cerebellum rapidly modulates the activity of the striatum via a disynaptic pathway. Under physiological conditions this short latency pathway is capable of facilitating optimal motor control by allowing the basal ganglia to incorporate time-sensitive cerebellar information and by guiding the sign of cortico-striatal plasticity. Conversely, under pathological condition this pathway relays aberrant cerebellar activity to the basal ganglia to cause dystonia.
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Asahi T, Koh M, Kashiwazaki D, Kuroda S. Stereotactic neurosurgery for writer's cramp: report of two cases with an overview of the literature. Stereotact Funct Neurosurg 2014; 92:405-11. [PMID: 25359570 DOI: 10.1159/000366004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 07/14/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Writer's cramp is a specific movement disorder with hand muscle cramps in writing, being classified into focal and action-specific dystonia. Stereotactic surgery, such as thalamotomy and deep brain stimulation (DBS), has been reported for writer's cramp; however, the number of reported cases is still scarce and surgical procedures are also controversial. OBJECTIVES In this study, therefore, we present 2 patients who underwent thalamotomy for writer's cramp and systematically review the literature on stereotactic surgery for writer's cramp. METHODS Case reports and literature review are presented. RESULTS Both patients underwent ventral oral nucleus (Vo) thalamotomy safely. Their symptoms completely disappeared after surgery and did not recur during follow-up periods. In the literature, a total of 31 cases were surgically treated for writer's cramp. Stereotactic surgery included thalamotomy in 25 cases and DBS in 6. The target included the Vo in 17 cases, the ventral intermediate nucleus (Vim) in 3, and both Vo and Vim in 7. Both procedures markedly improved or resolved the symptoms. Transient neurological deficits were observed in 16.0% of patients after thalamotomy. CONCLUSIONS The Vo may be the most effective target to treat writer's cramp. Both thalamotomy and DBS are feasible and effective, but thalamotomy would be a better option, especially in younger or high-risk patients.
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Affiliation(s)
- Takashi Asahi
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan
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Taira T. [Role of neurosurgical management in movement disorders other than Parkinson disease]. Rinsho Shinkeigaku 2013; 53:966-8. [PMID: 24291848 DOI: 10.5692/clinicalneurol.53.966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Neurosurgical procedures are indispensable in management of various types of movement disorders (MD). Stereotactic operations that have been well established include deep brain stimulation for tremor, dystonia, and Parkinsonian symptoms. Recently the actual role of stereotactic ablative procedures such as thalamotomy and pallidotomy has been re-explored, and Vo thalamotomy shows long-term improvement of task specific focal dystonia like writer's cramp and musician's dystonia. A new less invasive treatment of tremor using MR guided focused ultrasound has started and is promising. Intrathecal administration of baclofen is also an established treatment for severe spasticity, but other ablative procedures such as peripheral neurotomy and dorsal rhizotomy are also important in spasticity treatment. It seems that most neurologists are unfamiliar, at least in Japan, with such neurosurgical procedures. However, neurologists involved in management of MD should understand the important roles of neurosurgical management of intractable MD and should refer such patients to appropriate neurosurgeons before permanent contracture and deformity develop.
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Affiliation(s)
- Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University
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Charness ME. Brain surgery for musician's dystonia. Ann Neurol 2013; 74:627-9. [PMID: 23893466 DOI: 10.1002/ana.23975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Michael E Charness
- Veterans Affairs Boston Healthcare System Performing Arts Clinic, Department of Neurology, Brigham and Women's Hospital Department of Neurology, Harvard Medical School and Department of Neurology, Boston University School of Medicine, Boston, MA
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Jinnah HA, Berardelli A, Comella C, Defazio G, Delong MR, Factor S, Galpern WR, Hallett M, Ludlow CL, Perlmutter JS, Rosen AR. The focal dystonias: current views and challenges for future research. Mov Disord 2013; 28:926-43. [PMID: 23893450 PMCID: PMC3733486 DOI: 10.1002/mds.25567] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/15/2013] [Accepted: 05/16/2013] [Indexed: 11/11/2022] Open
Abstract
The most common forms of dystonia are those that develop in adults and affect a relatively isolated region of the body. Although these adult-onset focal dystonias are most prevalent, knowledge of their etiologies and pathogenesis has lagged behind some of the rarer generalized dystonias, in which the identification of genetic defects has facilitated both basic and clinical research. This summary provides a brief review of the clinical manifestations of the adult-onset focal dystonias, focusing attention on less well understood clinical manifestations that need further study. It also provides a simple conceptual model for the similarities and differences among the different adult-onset focal dystonias as a rationale for lumping them together as a class of disorders while at the same time splitting them into subtypes. The concluding section outlines some of the most important research questions for the future. Answers to these questions are critical for advancing our understanding of this group of disorders and for developing novel therapeutics.
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Affiliation(s)
- H A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia 30322, USA.
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