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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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Hirt L, Grassia F, Feuerstein J, Thompson JA, Ojemann S, Kern DS. Deep Brain Stimulation of the Ventral Intermediate Nucleus of the Thalamus in Writer's Cramp: A Case Report. Tremor Other Hyperkinet Mov (N Y) 2021; 11:46. [PMID: 34824889 PMCID: PMC8588894 DOI: 10.5334/tohm.645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Globus pallidus internus (GPi) deep brain stimulation (DBS) and thalamotomy are interventions for writer's cramp (WC). Ventralis intermedius nucleus (VIM) DBS is targeted for tremor, however, many aspects of VIM DBS remained underexplored in WC. Case Report A 62-year-old man with WC underwent DBS. Dystonic tremor improved intraoperatively with ventralis oralis anterior (VoA)/ventral oralis posterior (VoP) and with subthalamic nucleus stimulation; although greatest benefit was obtained with VIM stimulation. Sustained benefit with VIM DBS at ten months post-operative was obtained. Discussion This case demonstrates an intraoperative approach in target selection and supports benefits of VIM DBS for WC. Highlights This case highlights the intraoperative approach and clinical effects of VIM DBS in the treatment of medically refractory writer's cramp (WC). We contextualize our results from this case with previous reports of VoA/VoP stimulation for WC.
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Affiliation(s)
- Lisa Hirt
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
| | - Fabio Grassia
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
| | - Jeanne Feuerstein
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, US
- Department of Neurology, Rocky Mountain Regional VA Medical Center, Aurora, CO, US
| | - John A. Thompson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, US
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, US
| | - Drew S. Kern
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO, US
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, US
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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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Horisawa S, Kohara K, Nonaka T, Mochizuki T, Kawamata T, Taira T. Case Report: Deep Cerebellar Stimulation for Tremor and Dystonia. Front Neurol 2021; 12:642904. [PMID: 33746894 PMCID: PMC7973230 DOI: 10.3389/fneur.2021.642904] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The cerebellum plays an important role in the pathogenesis and pathophysiology of movement disorders, including tremor and dystonia. To date, there have been few reports on deep cerebellar stimulation. Case Report: The patient was a 35-year-old previously healthy man with no history of movement disorders. He developed a tremor and stiffness in his left hand at the age of 27 years, which was diagnosed as a dystonic tremor. We performed right thalamotomy, which resulted in a complete resolution of the tremor; however, the dystonia persisted. Subsequently, the patient developed left foot dystonia with inversion and a newly developed tremor in the right hand and foot. The patient underwent left ventralis intermedius (VIM) deep brain stimulation (VIM-DBS) and left pallidothalamic tract DBS (PTT-DBS). Left VIM-DBS completely resolved the right hand and foot tremor, and PTT-DBS significantly improved the left hand and foot dystonia. Three months postoperatively, the patient developed an infection and wound disruption at the surgical site. We performed palliative surgery for deep cerebellar stimulation via the posterior cranial region, which was not infected. The surgery was performed under general anesthesia with the patient lying in the prone position. Eight contact DBS electrodes were used. The placement of electrodes extended from the superior cerebellar peduncle to the dentate nucleus. Both the right hand and foot tremor improved with right cerebellar stimulation. Further, both the left hand and foot dystonia improved with left cerebellar stimulation. Right and left cerebellar stimulation led to no improvement in the left hand and foot dystonia and right hand and foot tremor, respectively. Stimulation-induced complications observed in the patient included dizziness, dysphagia, and dysarthria. After the surgery, the patient developed hypersalivation and hyperhidrosis in the left side of the body, both of which did not improve with adjustments of stimulation parameters. At the 6-month follow-up, the tremor and dystonia had almost completely resolved. Conclusion: Deep cerebellar stimulation deserves consideration as a potential treatment for tremor and dystonia.
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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
| | - Taku Nonaka
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuki Mochizuki
- 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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Macerollo A, Sajin V, Bonello M, Barghava D, Alusi SH, Eldridge PR, Osman-Farah J. Deep brain stimulation in dystonia: State of art and future directions. J Neurosci Methods 2020; 340:108750. [DOI: 10.1016/j.jneumeth.2020.108750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/03/2023]
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Murgai AA, Jog M. Focal limb dystonia and tremor: Clinical update. Toxicon 2020; 176:10-14. [PMID: 31965968 DOI: 10.1016/j.toxicon.2020.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Abstract
The association between tremor and dystonia has been known for many decades. Dystonic tremor is seen in the body part affected with dystonia. Tremor and dystonia can also co-exist in different body parts. Subtle dystonic posturing can be missed in patients with upper limb tremor and these patients are often misdiagnosed as essential tremor. Careful clinical examination and electrophysiology may help in differentiating classical essential tremor from dystonic tremor. Writer's cramp, a common focal hand dystonia can mimic primary writing tremor when the dystonic posturing is subtle. Oral medications have limited therapeutic efficacy. Botulinum toxin is considered as first line therapy for focal limb dystonia and is also effective in the treatment of tremor. Surgical options are reserved for cases refractory to medical therapy. In this review, we summarize the current state of knowledge of focal limb dystonia and tremor with a focus on underlying neurophysiology in these conditions.
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Affiliation(s)
- Aditya Ashok Murgai
- Department of Clinical Neurological Sciences, Western University, London, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, Canada.
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Lizarraga KJ, Al-Shorafat D, Fox S. Update on current and emerging therapies for dystonia. Neurodegener Dis Manag 2019; 9:135-147. [PMID: 31117876 DOI: 10.2217/nmt-2018-0047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Treatment strategies for dystonia depend on the focal, segmental or generalized distribution of symptoms. Chemodenervation with botulinum toxin remains the treatment of choice for focal- or select-body regions in generalized and segmental dystonia. A potentially longer acting formulation of botulinum toxin is being investigated besides the currently available formulations. Electromyography increases toxin injection accuracy and may reduce injection number, frequency, side effects and costs by identifying dystonic muscle activity. Oral anticholinergics, baclofen and clonazepam are used off-label, but novel drugs in development include sodium oxybate, zonisamide and perampanel. Characterizing dystonia as a sensorimotor circuit disorder has prompted the use of noninvasive neuromodulation procedures. These techniques need further study but simultaneous rehabilitation techniques appear to also improve outcomes. Pallidal deep-brain stimulation is beneficial for medication-refractory primary generalized and possibly focal dystonia such as cervical dystonia. Certain genetic conditions are amenable to specific therapies and future gene-targeted therapies could benefit selected dystonia patients.
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Affiliation(s)
- Karlo J Lizarraga
- The Edmond J Safra Program in Parkinson's Disease & the Morton & Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, M5T2S8 ON, Canada
| | - Duha Al-Shorafat
- The Edmond J Safra Program in Parkinson's Disease & the Morton & Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, M5T2S8 ON, Canada
| | - Susan Fox
- The Edmond J Safra Program in Parkinson's Disease & the Morton & Gloria Shulman Movement Disorders Clinic, Division of Neurology, Department of Medicine, Toronto Western Hospital, University of Toronto, Toronto, M5T2S8 ON, Canada
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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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Park Y, Jung NY, Na YC, Chang JW. Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor. Mov Disord 2019; 34:727-734. [DOI: 10.1002/mds.27637] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yong‐Sook Park
- Department of NeurosurgeryChung‐Ang University College of Medicine Seoul Korea
| | - Na Young Jung
- Department of NeurosurgeryBrain Research Institute, Yonsei University College of Medicine Seoul Korea
| | - Young Cheol Na
- Department of NeurosurgeryCatholic Kwandong University College of Medicine, International St. Mary's Hospital Incheon Korea
| | - Jin Woo Chang
- Department of NeurosurgeryBrain Research Institute, Yonsei University College of Medicine Seoul Korea
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11
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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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12
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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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13
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Zhang YQ, Wang JW, Wang YP, Zhang XH, Li JP. Thalamus Stimulation for Myoclonus Dystonia Syndrome: Five Cases and Long-Term Follow-up. World Neurosurg 2018; 122:e933-e939. [PMID: 30419400 DOI: 10.1016/j.wneu.2018.10.177] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/24/2018] [Accepted: 10/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myoclonic dystonia syndrome (MDS) is a rare inherited movement disorder characterized by the coexistence of myoclonic jerks and dystonia. Deep brain stimulation (DBS) is a promising treatment for patients with MDS that targets the globus pallidus internus or ventral intermediate nucleus (Vim) of the thalamus. However, there are few studies regarding the long-term effects of Vim DBS in patients with MDS and even fewer in those without gene mutations. METHODS Two positive and three negative SGCE mutation patients presenting with predominant myoclonus underwent Vim DBS. The Unified Myoclonus Rating Scale and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) were assessed pre- and postoperation. RESULTS Over an average follow-up period of 50 months, the myoclonus improvement rate was 92.7%. The average improvement in the BFMDRS motor score was 71.4% and the average improvement in the BFMDRS disabling score was 75.8%. CONCLUSIONS This study suggests that Vim DBS can be a safe and effective treatment option for patients with MDS. Vim DBS alone may be preferable for patients with myoclonus-dominated MDS regardless of the identification of an SGCE mutation. Additional globus pallidus internus DBS may be used for progressive dystonia after Vim DBS.
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Affiliation(s)
- Yu-Qing Zhang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia-Wei Wang
- Department of Neurosurgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yun-Peng Wang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiao-Hua Zhang
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ji-Ping Li
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Treatment of a Patient With Task-Specific Writing Tremor Using Magnetic Resonance-Guided Focused Ultrasound. Can J Neurol Sci 2018; 45:474-477. [PMID: 29734963 DOI: 10.1017/cjn.2018.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Task-specific dystonia is characterized by abnormal repetitive movements or postures in a specific body part that is triggered and ends with a task, such as writing. Failing medications, surgery, specifically disruption of key nuclei in the thalamus, can provide excellent symptomatic relief. Transcranial magnetic resonance (MR)-guided focused ultrasound is an emerging incision-less thermoablation technique. We describe MR-guided focused ultrasound tandem ablation of the ventral intermediate and ventralis oralis posterior nuclei in a 60-year-old patient with writer's cramp. The clinical improvement was immediate with incremental benefit from the latter lesion, which was sustained at 6 months follow-up.
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15
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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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16
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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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17
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Doshi PK, Shaikh S, Karkera B, Ramdasi R. Stereotactic Thalamotomy for Task‐Specific Dystonia. Mov Disord Clin Pract 2017. [DOI: 10.1002/mdc3.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Paresh K. Doshi
- Department of Neurosurgery Jaslok Hospital and Research Center Mumbai India
| | - Shabana Shaikh
- Department of Neurosurgery Jaslok Hospital and Research Center Mumbai India
| | - Bharati Karkera
- Department of Neurosurgery Jaslok Hospital and Research Center Mumbai India
| | - Raghvendra Ramdasi
- Department of Neurosurgery Jaslok Hospital and Research Center Mumbai India
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18
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Wang JW, Li JP, Wang YP, Zhang XH, Zhang YQ. Deep brain stimulation for myoclonus-dystonia syndrome with double mutations in DYT1 and DYT11. Sci Rep 2017; 7:41042. [PMID: 28102337 PMCID: PMC5244480 DOI: 10.1038/srep41042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022] Open
Abstract
Myoclonus-dystonia syndrome (MDS) is a rare autosomal dominant inherited disorder characterized by the presentation of both myoclonic jerks and dystonia. Evidence is emerging that deep brain stimulation (DBS) may be a promising treatment for MDS. However, there are no studies reporting the effects of DBS on MDS with double mutations in DYT1 and DYT11. Two refractory MDS patients with double mutations were treated between 2011 and 2015 in our center. Genetic testing for DYT1 and DYT11 was performed through polymerase chain reaction amplification and direct sequencing of the specific exons of genes. For the first patient, initial bilateral ventral intermediate thalamus nucleus (Vim) DBS was performed. Because of worsening dystonia after initial improvement in symptoms, subsequent bilateral globus pallidus internus (GPi) DBS was offered at 43 months after initial surgery, which reversed the deterioration and restored the motor function. For the second patient, initial improvement in motor symptoms and quality of life was sustained at the follow-up 6 months after bilateral Vim DBS treatment. Thus, DBS may be an effective therapeutic option for MDS, even in patients with double mutations. Moreover, GPi DBS may be used as a supplementary treatment when initial Vim DBS fails to control MDS symptoms.
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Affiliation(s)
- Jia-Wei Wang
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, P.R. China
| | - Ji-Ping Li
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, P.R. China
| | - Yun-Peng Wang
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, P.R. China
| | - Xiao-Hua Zhang
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, P.R. China
| | - Yu-Qing Zhang
- Beijing Institute of Functional Neurosurgery, Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, P.R. China
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19
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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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20
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Sadnicka A, Kassavetis P, Pareés I, Meppelink AM, Butler K, Edwards M. Task-specific dystonia: pathophysiology and management. J Neurol Neurosurg Psychiatry 2016; 87:968-74. [PMID: 26818730 DOI: 10.1136/jnnp-2015-311298] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/22/2015] [Indexed: 12/23/2022]
Abstract
Task-specific dystonia is a form of isolated focal dystonia with the peculiarity of being displayed only during performance of a specific skilled motor task. This distinctive feature makes task-specific dystonia a particularly mysterious and fascinating neurological condition. In this review, we cover phenomenology and its increasingly broad-spectrum risk factors for the disease, critically review pathophysiological theories and evaluate current therapeutic options. We conclude by highlighting the unique features of task-specific dystonia within the wider concept of dystonia. We emphasise the central contribution of environmental risk factors, and propose a model by which these triggers may impact on the motor control of skilled movement. By viewing task-specific dystonia through this new lens which considers the disorder a modifiable disorder of motor control, we are optimistic that research will yield novel therapeutic avenues for this highly motivated group of patients.
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Affiliation(s)
- Anna Sadnicka
- Sobell Department for Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, UK
| | | | - Isabel Pareés
- Department of Neurology, San Carlos Health Research Institute (IdISSC) Universidad Complutense de Madrid, Madrid, Spain
| | - Anne Marthe Meppelink
- Department of Neurology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Katherine Butler
- Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Mark Edwards
- Institute of Cardiovascular and Cell Sciences, St George's University, London, UK
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21
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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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22
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Horisawa S, Goto S, Takeda N, Takano Y, Kawamata T, Taira T. Pallidotomy for Writer's Cramp after Failed Thalamotomy. Stereotact Funct Neurosurg 2016; 94:129-33. [DOI: 10.1159/000445693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 03/21/2016] [Indexed: 11/19/2022]
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23
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Wichmann T, DeLong MR. Deep Brain Stimulation for Movement Disorders of Basal Ganglia Origin: Restoring Function or Functionality? Neurotherapeutics 2016; 13:264-83. [PMID: 26956115 PMCID: PMC4824026 DOI: 10.1007/s13311-016-0426-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Deep brain stimulation (DBS) is highly effective for both hypo- and hyperkinetic movement disorders of basal ganglia origin. The clinical use of DBS is, in part, empiric, based on the experience with prior surgical ablative therapies for these disorders, and, in part, driven by scientific discoveries made decades ago. In this review, we consider anatomical and functional concepts of the basal ganglia relevant to our understanding of DBS mechanisms, as well as our current understanding of the pathophysiology of two of the most commonly DBS-treated conditions, Parkinson's disease and dystonia. Finally, we discuss the proposed mechanism(s) of action of DBS in restoring function in patients with movement disorders. The signs and symptoms of the various disorders appear to result from signature disordered activity in the basal ganglia output, which disrupts the activity in thalamocortical and brainstem networks. The available evidence suggests that the effects of DBS are strongly dependent on targeting sensorimotor portions of specific nodes of the basal ganglia-thalamocortical motor circuit, that is, the subthalamic nucleus and the internal segment of the globus pallidus. There is little evidence to suggest that DBS in patients with movement disorders restores normal basal ganglia functions (e.g., their role in movement or reinforcement learning). Instead, it appears that high-frequency DBS replaces the abnormal basal ganglia output with a more tolerable pattern, which helps to restore the functionality of downstream networks.
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Affiliation(s)
- Thomas Wichmann
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
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24
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Cutsforth-Gregory JK, Ahlskog JE, McKeon A, Burnett MS, Matsumoto JY, Hassan A, Bower JH. Repetitive exercise dystonia: A difficult to treat hazard of runner and non-runner athletes. Parkinsonism Relat Disord 2016; 27:74-80. [PMID: 27017145 DOI: 10.1016/j.parkreldis.2016.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/29/2016] [Accepted: 03/17/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Runner's dystonia has previously been described in small series or case reports as a lower limb, task-specific dystonia. We have occasionally encountered this disorder and recognized the same phenomenon in non-runners regularly engaging in lower limb exercise. We wished to characterize the syndrome further, including outcomes, treatment, and the diagnostic usefulness of electrophysiology. METHODS We conducted a retrospective review and follow-up survey of adults seen at Mayo Clinic (1996-2015) with task-specific dystonia arising after prolonged repetitive lower limb exercise. The findings were compared to all 21 previously reported cases of runner's dystonia. RESULTS We identified 20 patients with this condition, 13 runners and seven non-runner athletes. Median age at dystonia onset was in mid-adulthood. Correct diagnosis was delayed by a median of 3.5 years in runners and 1.6 years in non-runners, by which time more than one-third of patients had undergone unsuccessful invasive procedures. Most patients had dystonia onset in the distal lower limb. Dystonia was task-specific with exercise at onset but progressed to affect walking in most. Sensory tricks were reported in some. Surface EMG was consistent with task-specific dystonia in nine patients. Botulinum toxin, levodopa, clonazepam, trihexyphenidyl, and physical therapy provided modest benefit to some, but all patients remained substantially symptomatic at last follow up. CONCLUSIONS Repetitive exercise dystonia is task-specific, confined to the lower limb and occasionally trunk musculature. It tends to be treatment-refractory and limits ability to exercise. Diagnosis is typically delayed, and unnecessary surgical procedures are common. Surface EMG may aid the diagnosis.
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Affiliation(s)
| | - J Eric Ahlskog
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | | | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
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Abstract
Writer's cramp is the most common form of focal, task-specific dystonia. Symptoms frequently evolve in the setting of repetitive hand movements and increased writing demands, and clinical presentations demonstrate a variety of different dystonic patterns of the upper extremity such as while writing or holding a writing utensil. However, why writer's cramp develops still remains much of a mystery. Clinical evaluation of patients with writer's cramp and various theories regarding its pathophysiology are reviewed. Treatment can be challenging and often involves a combination of pharmacologic (e.g., oral medications, botulinum toxin injections) and non-pharmacologic approaches (e.g., neurosurgical or neurostimulatory interventions, rehabilitation therapies, adaptive devices). Management strategies for writer's cramp using both of these approaches will be discussed.
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Affiliation(s)
- Jennifer G Goldman
- Rush University Medical Center, Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, USA.
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