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Tewari AR, Grogan DP, Maragkos GA, Elias WJ, Moosa S. A New Era for Lesioning in Parkinson Disease. World Neurosurg 2023; 179:236-237. [PMID: 37716815 DOI: 10.1016/j.wneu.2023.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Affiliation(s)
- Anant R Tewari
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Dayton P Grogan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Georgios A Maragkos
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - W Jeffrey Elias
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Shayan Moosa
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA
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2
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Maragkos GA, Kosyakovsky J, Zhao P, Kearns KN, Rush-Evans S, Moosa S, Elias WJ. Patient-Reported Outcomes After Focused Ultrasound Thalamotomy for Tremor-Predominant Parkinson's Disease. Neurosurgery 2023; 93:884-891. [PMID: 37133259 DOI: 10.1227/neu.0000000000002518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) has emerged as a precise, incisionless approach to cerebral lesioning and an alternative to neuromodulation in movement disorders. Despite rigorous clinical trials, long-term patient-centered outcome data after MRgFUS for tremor-predominant Parkinson's Disease (TPPD) are relatively lacking. OBJECTIVE To report long-term data on patient satisfaction and quality of life after MRgFUS thalamotomy for TPPD. METHODS In a retrospective study of patients who underwent MRgFUS thalamotomy for TPPD at our institution between 2015 and 2022, a patient survey was administered to collect self-reported measures of tremor improvement, recurrence, Patients' Global Impression of Change (PGIC), and side effects. Patient demographics, FUS parameters, and lesion characteristics were analyzed. RESULTS A total of 29 patients were included with a median follow-up of 16 months. Immediate tremor improvement was achieved in 96% of patients. Sustained improvement was achieved in 63% of patients at last follow-up. Complete tremor recurrence to baseline occurred for 17% of patients. Life quality improvement denoted by a PGIC of 1 to 2 was reported by 69% of patients. Long-term side effects were reported by 38% of patients and were mostly mild. Performing a secondary anteromedial lesion to target the ventralis oralis anterior/posterior nucleus was associated with higher rates of speech-related side effects (56% vs 12%), without significant improvement in tremor outcomes. CONCLUSION Patient satisfaction with FUS thalamotomy for tremor-predominant PD was very high, even at longer term. Extended lesioning to target the motor thalamus did not improve tremor control and may contribute to greater frequency of postoperative motor- and speech-related side effects.
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Affiliation(s)
- Georgios A Maragkos
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Jacob Kosyakovsky
- University of Virginia School of Medicine, Charlottesville , Virginia , USA
| | - Patricia Zhao
- University of Virginia School of Medicine, Charlottesville , Virginia , USA
| | - Kathryn N Kearns
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Shelly Rush-Evans
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Shayan Moosa
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - W Jeffrey Elias
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
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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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Corp DT, Morrison-Ham J, Jinnah HA, Joutsa J. The functional anatomy of dystonia: Recent developments. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:105-136. [PMID: 37482390 DOI: 10.1016/bs.irn.2023.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
While dystonia has traditionally been viewed as a disorder of the basal ganglia, the involvement of other key brain structures is now accepted. However, just what these structures are remains to be defined. Neuroimaging has been an especially valuable tool in dystonia, yet traditional cross-sectional designs have not been able to separate causal from compensatory brain activity. Therefore, this chapter discusses recent studies using causal brain lesions, and animal models, to converge upon the brain regions responsible for dystonia with increasing precision. This evidence strongly implicates the basal ganglia, thalamus, brainstem, cerebellum, and somatosensory cortex, yet shows that different types of dystonia involve different nodes of this brain network. Nearly all of these nodes fall within the recently identified two-way networks connecting the basal ganglia and cerebellum, suggesting dysfunction of these specific pathways. Localisation of the functional anatomy of dystonia has strong implications for targeted treatment options, such as deep brain stimulation, and non-invasive brain stimulation.
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Affiliation(s)
- Daniel T Corp
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia; Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, United States.
| | - Jordan Morrison-Ham
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, Australia
| | - H A Jinnah
- Departments of Neurology, Human Genetics, and Pediatrics, Atlanta, GA, United States
| | - Juho Joutsa
- Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, MA, United States; Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland; Turku PET Centre, Neurocenter, Turku University Hospital, Turku, Finland
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5
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Murakami M, Horisawa S, Azuma K, Akagawa H, Nonaka T, Kawamata T, Taira T. Case Report: Long-Term Suppression of Paroxysmal Kinesigenic Dyskinesia After Bilateral Thalamotomy. Front Neurol 2021; 12:789468. [PMID: 34925221 PMCID: PMC8678037 DOI: 10.3389/fneur.2021.789468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder characterized by transient dyskinetic movements, including dystonia, chorea, or both, triggered by sudden voluntary movements. Carbamazepine and other antiepileptic drugs (AEDs) are widely used in the treatment of PKD, and they provide complete remission in 80–90% of medically treated patients. However, the adverse effects of AEDs include drowsiness and dizziness, which interfere with patients' daily lives. For those with poor compatibility with AEDs, other treatment approaches are warranted. Case Report: A 19-year-old man presented to our institute with right hand and foot dyskinesia. He had a significant family history of PKD; his uncle, grandfather, and grandfather's brother had PKD. The patient first experienced paroxysmal involuntary left hand and toe flexion with left forearm pronation triggered by sudden voluntary movements at the age of 14. Carbamazepine (100 mg/day) was prescribed, which led to a significant reduction in the frequency of attacks. However, carbamazepine induced drowsiness, which significantly interfered with his daily life, especially school life. He underwent right-sided ventro-oral (Vo) thalamotomy at the age of 15, which resulted in complete resolution of PKD attacks immediately after the surgery. Four months after the thalamotomy, he developed right elbow, hand, and toe flexion. He underwent left-sided Vo thalamotomy at the age of 19. Immediately after the surgery, the PKD attacks resolved completely. However, mild dysarthria developed, which spontaneously resolved within three months. Left-sided PKD attacks never developed six years after the right Vo thalamotomy, and right-sided PKD attacks never developed two years after the left Vo thalamotomy without medication. Conclusion: The present case showed long-term suppression of bilateral PKDs after bilateral thalamotomy, which led to drug-free conditions.
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Affiliation(s)
- Masato Murakami
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenko Azuma
- Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Akagawa
- Institute for Integrated Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
| | - Taku Nonaka
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- 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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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:life11080776. [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] [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.)
- Correspondence:
| | - 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: 18] [Impact Index Per Article: 6.0] [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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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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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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Ghanchi H, Siddiqi I, Patchana T, Ananda A. Acquired Holmes Tremor in a Human Immunodeficiency Virus Immune Reconstitution Inflammatory Syndrome Patient Treated with Deep Brain Stimulation. World Neurosurg 2020; 141:253-259. [PMID: 32565375 DOI: 10.1016/j.wneu.2020.06.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The authors present a case of a 66-year-old male who was diagnosed with human immunodeficiency virus, and his medical course of highly active antiretroviral therapy was complicated with the development of immune reconstitution inflammatory syndrome, which led to development of movement disorder consisting of right-sided resting tremor, neck dystonia, and jaw clenching. CASE DESCRIPTION The patient's symptoms resembled that of rubral tremor, and he underwent placement of a deep brain stimulation electrode into the left ventral intermediate nucleus of the thalamus with significant improvement of symptoms. CONCLUSIONS This is the first reported case in the literature of a human immunodeficiency virus-positive patient's treatment course complicated with immune reconstitution inflammatory syndrome with neurologic manifestation, which was refractory to medical therapy and thus treated with deep brain stimulation.
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Affiliation(s)
- Hammad Ghanchi
- Riverside University Health System, Department of Neurosurgery, Riverside, California, USA.
| | - Imran Siddiqi
- Western University of Health Science, College of Osteopathic Medicine, Pomona, California, USA
| | - Tye Patchana
- Riverside University Health System, Department of Neurosurgery, Riverside, California, USA
| | - Ajay Ananda
- Kaiser Permanente Los Angeles Medical Center, Department of Neurosurgery, Los Angeles, California, USA
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12
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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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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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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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Hirato M, Miyagishima T, Takahashi A, Yoshimoto Y. Stereotactic Selective Thalamotomy for Focal Dystonia with Aid of Depth Microrecording. World Neurosurg 2018; 117:e349-e361. [PMID: 29909211 DOI: 10.1016/j.wneu.2018.06.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Long-term effectiveness of selective ventralis intermedius nucleus (VIM)-ventralis oralis nucleus (VO) thalamotomy with depth microrecording for the treatment of focal dystonia was evaluated. The optimal thalamic areas for controlling focal dystonia were studied based on the electrophysiologic and anatomic data. METHODS Stereotactic selective VIM-VO thalamotomy with depth microrecording was carried out in 8 patients with focal arm and hand dystonia and in 1 patient with cervical dystonia. Electrophysiologic data on the lateral part of thalamic VIM were studied in patients with focal dystonia. A very small and narrow therapeutic lesion was formed in the shape of a square on the sagittal plane and of an I, rotated V, Y, or inverse Y on the axial plane in the VIM-VO, which covered the kinesthetic response area topographically related to focal dystonia. Patients with arm and hand dystonia were followed up for 4.7 ± 3.0 years and 1 patient with cervical dystonia was followed up for 18.2 years. RESULTS Marked improvement of focal dystonia was shown by functional assessment using the Unified Dystonia Rating Scale. Transient dysarthria was recognized in 1 patient. The sequence of body localization of kinesthetic response in the VIM was clearly shown in patients with focal dystonia. Decreases in the amplitude and amplitude ratio of electromyography on the forearm muscles were markedly significant after VIM thalamotomy, but insignificant after VO thalamotomy immediately after VIM thalamotomy. CONCLUSIONS Marked reduction of electromyographic tonic discharges of focal dystonia was shown after VIM lesioning. Selective VIM-VO thalamotomy showed good and long-term stable effects for focal dystonia.
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Affiliation(s)
- Masafumi Hirato
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Takaaki Miyagishima
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akio Takahashi
- Department of Neurosurgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Gunma, Japan
| | - Yuhei Yoshimoto
- Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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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: 6] [Impact Index Per Article: 1.0] [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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Fasano A, Llinas M, Munhoz RP, Hlasny E, Kucharczyk W, Lozano AM. MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes. Neurology 2017; 89:771-775. [PMID: 28747452 DOI: 10.1212/wnl.0000000000004268] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 05/30/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report the 6-month single-blinded results of unilateral thalamotomy with MRI-guided focused ultrasound (MRgFUS) in patients with tremors other than essential tremor. METHODS Three patients with tremor due to Parkinson disease, 2 with dystonic tremor in the context of cervicobrachial dystonia and writer's cramp, and 1 with dystonia gene-associated tremor underwent MRgFUS targeting the ventro-intermedius nucleus (Vim) of the dominant hemisphere. The primary endpoint was the reduction of lateralized items of the Tremor Rating Scale of contralateral hemibody assessed by a blinded rater. RESULTS All patients achieved a statistically significant, immediate, and sustained improvement of the contralateral tremor score by 42.2%, 52.0%, 55.9%, and 52.9% at 1 week and 1, 3, and 6 months after the procedure, respectively. All patients experienced transient side effects and 2 patients experienced persistent side effects at the time of last evaluation: hemitongue numbness and hemiparesis with hemihypoesthesia. CONCLUSIONS Vim MRgFUS is a promising, incision-free, but nevertheless invasive technique to effectively treat tremors other than essential tremor. Future studies on larger samples and longer follow-up will further define its effectiveness and safety. CLINICALTRIALSGOV IDENTIFIER NCT02252380. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with tremor not caused by essential tremor, MRgFUS of the Vim improves the tremor of the contralateral hemibody at 6 months.
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Affiliation(s)
- Alfonso Fasano
- From the Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease (A.F., R.P.M.), Toronto Western Hospital-UHN, Division of Neurology, University of Toronto; Krembil Research Institute (A.F.); Division of Neurosurgery (M.L., A.M.L.), Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto; Joint Department of Medical Imaging (E.H., W.K.), University Health Network; and Department of Medical Imaging (W.K.), University of Toronto, Ontario, Canada.
| | - Maheleth Llinas
- From the Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease (A.F., R.P.M.), Toronto Western Hospital-UHN, Division of Neurology, University of Toronto; Krembil Research Institute (A.F.); Division of Neurosurgery (M.L., A.M.L.), Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto; Joint Department of Medical Imaging (E.H., W.K.), University Health Network; and Department of Medical Imaging (W.K.), University of Toronto, Ontario, Canada
| | - Renato P Munhoz
- From the Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease (A.F., R.P.M.), Toronto Western Hospital-UHN, Division of Neurology, University of Toronto; Krembil Research Institute (A.F.); Division of Neurosurgery (M.L., A.M.L.), Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto; Joint Department of Medical Imaging (E.H., W.K.), University Health Network; and Department of Medical Imaging (W.K.), University of Toronto, Ontario, Canada
| | - Eugen Hlasny
- From the Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease (A.F., R.P.M.), Toronto Western Hospital-UHN, Division of Neurology, University of Toronto; Krembil Research Institute (A.F.); Division of Neurosurgery (M.L., A.M.L.), Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto; Joint Department of Medical Imaging (E.H., W.K.), University Health Network; and Department of Medical Imaging (W.K.), University of Toronto, Ontario, Canada
| | - Walter Kucharczyk
- From the Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease (A.F., R.P.M.), Toronto Western Hospital-UHN, Division of Neurology, University of Toronto; Krembil Research Institute (A.F.); Division of Neurosurgery (M.L., A.M.L.), Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto; Joint Department of Medical Imaging (E.H., W.K.), University Health Network; and Department of Medical Imaging (W.K.), University of Toronto, Ontario, Canada
| | - Andres M Lozano
- From the Morton and Gloria Shulman Movement Disorders Clinic and Edmond J. Safra Program in Parkinson's Disease (A.F., R.P.M.), Toronto Western Hospital-UHN, Division of Neurology, University of Toronto; Krembil Research Institute (A.F.); Division of Neurosurgery (M.L., A.M.L.), Department of Surgery, Krembil Neuroscience Centre, Toronto Western Hospital, University of Toronto; Joint Department of Medical Imaging (E.H., W.K.), University Health Network; and Department of Medical Imaging (W.K.), University of Toronto, Ontario, Canada
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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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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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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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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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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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Mure H, Morigaki R, Koizumi H, Okita S, Kawarai T, Miyamoto R, Kaji R, Nagahiro S, Goto S. Deep Brain Stimulation of the Thalamic Ventral Lateral Anterior Nucleus for DYT6 Dystonia. Stereotact Funct Neurosurg 2014; 92:393-6. [DOI: 10.1159/000365577] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/29/2014] [Indexed: 11/19/2022]
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Mills KA, Starr PA, Ostrem JL. Neuromodulation for dystonia: target and patient selection. Neurosurg Clin N Am 2013; 25:59-75. [PMID: 24262900 DOI: 10.1016/j.nec.2013.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Treatment of dystonia refractory to oral medications or botulinum toxin injections includes the use of deep brain stimulation (DBS). Expectations should be established based on patient-related factors, including type of dystonia, genetic cause, target symptoms, age at the time of surgery, disease duration, or the presence of fixed skeletal deformities. Premorbid conditions such as psychiatric illness and cognitive impairment should be considered. Target selection is an emerging issue in DBS for dystonia. Although efficacy has been established for targeting the globus pallidus internus for dystonia, other brain targets such as the subthalamic nucleus, thalamus, or cortex may be promising alternatives.
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Affiliation(s)
- Kelly A Mills
- UCSF Department of Neurology, PADRECC, San Francisco VA Medical Center, UCSF Box 1838, 1635 Divisadero Street, Suite 520, San Francisco, CA 94143-1838, USA
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25
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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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Horisawa S, Taira T, Goto S, Ochiai T, Nakajima T. Long-term improvement of musician's dystonia after stereotactic ventro-oral thalamotomy. Ann Neurol 2013; 74:648-54. [PMID: 23463596 DOI: 10.1002/ana.23877] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 02/02/2013] [Accepted: 02/15/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Musician's dystonia is a task-specific movement disorder that causes twisting or repetitive abnormal finger postures and movements, which tend to occur only while playing musical instruments. Such a movement disorder will probably lead to termination of the careers of affected professional musicians. Most of the currently available treatments have yet to provide consistent and satisfactory results. We present the long-term follow-up results of ventro-oral thalamotomy for 15 patients with musician's dystonia. METHODS Between October 2003 and September 2010, 15 patients with medically intractable task-specific focal hand dystonia that occurred only while playing musical instruments underwent ventro-oral thalamotomy. We used Tubiana's musician's dystonia scale to evaluate the patients' pre- and postoperative neurological conditions. RESULTS All patients except 1 (93%) experienced dramatic improvement of dystonic symptoms immediately after ventro-oral thalamotomy. The mean follow-up period was 30.8 months (range=4-108 months). None of the patients experienced recurrence or deterioration of symptoms during the follow-up periods. INTERPRETATION Ventro-oral thalamotomy remarkably improved musician's dystonia, and the effect persisted for a long duration.
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Affiliation(s)
- Shiro Horisawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Abstract
Dystonia is defined as a syndrome of sustained muscle contractions, frequently causing twisting and repetitive movements, or abnormal postures. Its diagnosis is based on clinical characteristics. In dystonia, the pattern of abnormal posture or movement tends to be constant during the short term even if its severity fluctuates. This stereotypy often helps differentiate dystonia from psychogenic reaction. Dystonia may appear only during some specific task (task specificity) especially in its early phase, although it often becomes obscure during the long clinical course, resulting in persistent dystonic posture. Sensory trick or geste antagoniste means the change of severity triggered by some sensory input Overflow phenomenon is the activation of muscles unnecessary to a task, hampering purposeful movement. Symptoms tend to be milder in the morning, with large individual variation of its duration (morning benefit). Symptoms of dystonia may abruptly appear or disappear (flip-flop phenomenon). Cocontraction, believed as an essential feature of dystonia, reflects a loss of reciprocal inhibition of muscle activities, causing involuntary simultaneous contractions of agonists and antagonists. "Negative dystonia," still an unaccepted feature of dystonia, is defined as non-paretic loss of central driving of muscle activities necessary to a task. Apraxia of lid opening/closure, paretic form of hand dystonia, dropped head syndrome, camptocormia, Pisa syndrome, cervical dystonia with limited range of head movement, or mandibular dystonia without cocontractions of masticatory muscles, can be explained with this concept at least in a subset of cases. Treatment of dystonia includes medication, botulinum toxin injection, intrathecal baclofen, surgical intervention, acupuncture and other alternative therapies, rehabilitation, and psychotherapy. Oral medication is usually an adjunct to more potent therapeutic options except for some specific indications like dopa-responsive dystonia. Botulinum toxin is usually the treatment of choice for focal dystonia. Deep brain stimulation can be considered for both focal and non-focal phenotypes of dystonia.
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Deep brain stimulation for hyperkinetics disorders: dystonia, tardive dyskinesia, and tics. Curr Opin Neurol 2011; 23:420-5. [PMID: 20610993 DOI: 10.1097/wco.0b013e32833b7798] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW This review focuses on new insights in deep brain stimulation (DBS) for patients with hyperkinetic movement disorders: dystonia, tardive dyskinesia and Gille de la Tourette's syndrome, during the last 18 months. RECENT FINDINGS The recent literature confirms the efficacy of high-frequency stimulation of the globus pallidus internus (GPi) for primary dystonia, generalized or not, with a stable effect over time. The benefit of DBS in other forms of localized dystonia remains to be demonstrated in larger studies. Some clinical and radiological predictive factors have been determined with a predominant influence of the disease duration. Tardive dystonia and myoclonus-dystonia are also improved by GPi stimulation. Encouraging results obtained in cerebral palsy may pave the way for the application of DBS in other secondary dystonia. In Gilles de la Tourette's syndrome, both stimulation of the centre-median/parafascicular nucleus of the thalamus and GPi stimulation (ventromedial) have demonstrated efficacy with stable long-term effect. Thalamic stimulation failed to improve obsessions and compulsions in some patients. Stimulation of the nucleus accumbens has been tested in few cases with contradictory efficacy. In both diseases, complications are rare with no major side effects. SUMMARY The few controlled studies showed that bilateral GPi stimulation is a well tolerated and a long-term effective treatment for hyperkinetic disorders. However, recent published data of DBS applied in different targets or patients (especially secondary dystonia) are mainly uncontrolled case reports, precluding the clear determination of the efficacy of this procedure and the choice of the 'good' target for the 'good' patient.
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Novel nonpharmacologic perspectives for the treatment of task-specific focal hand dystonia. J Hand Ther 2009; 22:156-61; quiz 162. [PMID: 19278828 DOI: 10.1016/j.jht.2008.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 11/25/2008] [Accepted: 11/25/2008] [Indexed: 02/03/2023]
Abstract
NARRATIVE REVIEW: The pathophysiology of focal hand dystonia (FHD) has not yet been completely clarified. Although there is a loss of inhibition at multiple levels of the central nervous system, maladaptive plasticity of the cerebral cortex as well as impairments in sensory and motor representations have also been reported. All of these abnormalities can be viewed as an epiphenomenon of the primary--still unknown--abnormality underlying focal dystonia. The purpose of this review is to describe the underlying constructs of novel nonpharmacologic approaches for the treatment of FHD. Alternative or complementary approaches to botulinum toxin injections such as behavioral training strategies and brain stimulation techniques are reviewed. None of the proposed treatments appears to be definitive and applicable to all patients with FHD. Each treatment strategy elicited some benefit in a fraction of patients. The combination of more than one approach (retraining, immobilization, botulinum toxin, neuromodulation, etc.) could lead to a better control of FHD.
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Cho CB, Park HK, Lee KJ, Rha HK. Thalamic Deep Brain Stimulation for Writer's Cramp. J Korean Neurosurg Soc 2009; 46:52-5. [PMID: 19707494 DOI: 10.3340/jkns.2009.46.1.52] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 12/23/2008] [Accepted: 06/29/2009] [Indexed: 11/27/2022] Open
Abstract
Writer's cramp is a type of idiopathic focal hand dystonia characterized by muscle cramps that accompany execution of the writing task specifically. There has been renewed interest in neurosurgical procedures for the treatment of dystonia over the past several years. In particular, deep brain stimulation (DBS) has received increasing attention as a therapeutic option for patients with dystonia. However, to date, limited reporters made investigations into DBS in relation to the Writer's cramp. In this case, unilateral Ventro-oralis complex (Vo) DBS resulted in a major improvement in patient's focal dystonic movement disorders. Her post-operative Burke-Fahn-Marsden Dystonia Rating (BFMDR) scale demonstrated 1 compared with pre-operative BFMDR scale 4. We conclude that thalamic Vo complex DBS may be an important neurosurgical therapeutic option for Writer's cramp.
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Affiliation(s)
- Chul Bum Cho
- Department of Neurosurgery, Catholic Neuroscience Center, St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Kim MJ, Jeon SR, Yoo HW, Kim GH, Lee MC, Chung SJ. Effect of thalamotomy on focal hand dystonia in a family with DYT1 mutation. Mov Disord 2009; 23:2251-5. [PMID: 18823049 DOI: 10.1002/mds.22337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
We report the clinical and molecular features of a family with focal hand dystonia caused by DYT1 mutation. Four members of a family who underwent thalamotomy showed a marked and sustained therapeutic benefit that lasted for up to 12 years without recurrence of dystonia or any significant surgical complication. The hand dystonia caused by DYT1 mutation may be successfully managed by thalamotomy.
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Affiliation(s)
- Mi J Kim
- Department of Neurology, Center for Parkinsonism and Other Movement Disorders, University of Ulsan College of Medicine, Seoul, South Korea
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Fukaya C, Katayama Y, Kano T, Nagaoka T, Kobayashi K, Oshima H, Yamamoto T. Thalamic deep brain stimulation for writer's cramp. J Neurosurg 2007; 107:977-82. [PMID: 17977270 DOI: 10.3171/jns-07/11/0977] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Writer's cramp is a type of idiopathic focal hand dystonia characterized by muscle cramps that accompany execution of the writing task specifically. In this report, the authors describe the clinical outcome after thalamic deep brain stimulation (DBS) therapy in patients with writer's cramp and present an illustrative case with which they compare the effects of pallidal and thalamic stimulation. In addition to these results for the clinical effectiveness, they also examine the best point and pattern for therapeutic stimulation of the motor thalamus, including the nucleus ventrooralis (VO) and the ventralis intermedius nucleus (VIM), for writer's cramp. METHODS The authors applied thalamic DBS in five patients with writer's cramp. The inclusion criteria for the DBS trial in this disorder were a diagnosis of idiopathic writer's cramp and the absence of a positive response to medication. The exclusion criteria included significant cognitive dysfunction, active psychiatric symptoms, and evidence of other central nervous system diseases or other medical disorders. In one of the cases, DBS leads were implanted into both the globus pallidus internus and the VO/VIM, and test stimulation was performed for 1 week. The authors thus had an opportunity to compare the effects of pallidal and thalamic stimulation in this patient. RESULTS Immediately after the initiation of thalamic stimulation, the neurological deficits associated with writer's cramp were improved in all five cases. Postoperatively all preoperative scale scores indicating the seriousness of the writer's cramp were significantly lower (p < 0.001). In the patient in whom two DBS leads were implanted, the clinical effect of thalamic stimulation was better than that of pallidal stimulation. During the thalamic stimulation, the maximum effect was obtained when stimulation was applied to both the VO and the VIM widely, compared with being applied only within the VO. CONCLUSIONS The authors successfully treated patients with writer's cramp by thalamic DBS. Insofar as they are aware, this is the first series in which writer's cramp has been treated with DBS. Thalamic stimulation appears to be a safe and valuable therapeutic option for writer's cramp.
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Affiliation(s)
- Chikashi Fukaya
- Department of Neurological Surgery, Nihon University School of Medicine, Division of Applied System Neuroscience, Graduate School of Medical Science, Tokyo, Japan.
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Kruisdijk JJM, Koelman JHTM, Ongerboer de Visser BW, de Haan RJ, Speelman JD. Botulinum toxin for writer's cramp: a randomised, placebo-controlled trial and 1-year follow-up. J Neurol Neurosurg Psychiatry 2007; 78:264-70. [PMID: 17185301 PMCID: PMC2117645 DOI: 10.1136/jnnp.2005.083170] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Botulinum toxin type A (BoNT-A) has become the treatment of choice for most types of focal dystonia. OBJECTIVE To investigate the efficacy of BoNT-A injections in patients with writer's cramp in a double-blind, randomised, placebo-controlled trial and to evaluate the follow-up results. METHODS Forty participants were randomised to treatment with either BoNT-A or placebo injections in two sessions. Trial duration was 12 weeks. The primary outcome measure was the patients' choice to continue with the treatment, despite its possible disadvantages. Secondary outcome measures included several clinical rating scales on the levels of impairment and disability. Assessments were made at baseline and 2 months (secondary outcomes) and 3 months (primary outcome). Duration of follow-up was 1 year. RESULTS 39 patients completed the trial. Fourteen of 20 patients (70%) receiving BoNT-A reported a beneficial effect and chose to continue treatment, versus 6 of 19 patients (31.6%) in the placebo group (p = 0.03). The changes on most of the clinical rating scales were significantly in favour of BoNT-A. Side effects reported were hand weakness, which was mostly mild and always transient, and pain at the injection site. After 1 year, 20 of 39 patients were still under treatment with a positive effect. CONCLUSION Treatment with BoNT-A injections led to a significantly greater improvement compared with placebo, according to patients' opinion and clinical assessment scales. Weakness in the hand is an important side effect of BoNT-A injections, but despite this disadvantage, most patients preferred to continue treatment. About 50% of our patients were still under treatment after 1 year.
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Affiliation(s)
- J J M Kruisdijk
- Department of Neurology and Clinical Neurophysiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Shibata T, Hirashima Y, Ikeda H, Asahi T, Hayashi N, Endo S. Stereotactic Voa-Vop Complex Thalamotomy for Writer’s Cramp. Eur Neurol 2004; 53:38-9. [PMID: 15746551 DOI: 10.1159/000084262] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- T Shibata
- Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Toyama, Japan
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Taira T, Harashima S, Hori T. Neurosurgical treatment for writer's cramp. ACTA NEUROCHIRURGICA. SUPPLEMENT 2003; 87:129-31. [PMID: 14518539 DOI: 10.1007/978-3-7091-6081-7_27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND Writer's cramp is a type of focal dystonia due to dysfunction of the pallido-thalamo-cortical circuit. The symptom is refractory to most conservative treatment, though botulinum toxin injection is generally used for symptomatic relief. As a surgical treatment of dystonia we performed stereotactic nucleus ventrooralis (Vo) thalamotomy for dystonic cramp of the hand. METHOD Eight patients (5 men, 3 women, age 26-40 yrs, mean 32.1 yrs) with medically intractable task-specific focal dystonia of the hand underwent Vo thalamotomy. Stereotactic target was chosen at the junction of the anterior and posterior Vo nuclei. FINDINGS The mean duration of the symptom ranged from 3 to 6 years (mean, 4.0 yrs). All patients had complained of difficulty in writing. Six patients were professional workers, such as comic artist, guitarist, and barber, and, because of the dystonic symptoms at their professional work, they had stopped pursuing their profession. All patients showed immediate postoperative disappearance of dystonic symptoms, and the effect was sustained during the follow up period (3-29 months, mean 13.1 mo) except in one case. One patient showed partial recurrence of the symptom and underwent second thalamotomy 5 months after the initial surgery with satisfactory results. The score of the writer's cramp rating scale significantly (p < 0.001) decreased after Vo thalamotomy. There was no permanent operative complication. There was no mortality or permanent morbidity. INTERPRETATION Although a longer follow-up is needed, stereotactic Vo thalamotomy is a useful and safe therapeutic option for writer's cramp.
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Affiliation(s)
- T Taira
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
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Kiss ZHT, Wilkinson M, Krcek J, Suchowersky O, Hu B, Murphy WF, Hobson D, Tasker RR. Is the target for thalamic deep brain stimulation the same as for thalamotomy? Mov Disord 2003; 18:1169-75. [PMID: 14534922 DOI: 10.1002/mds.10524] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Deep brain stimulation (DBS) has virtually replaced thalamotomy for the treatment of essential tremor. It is thought that the site for DBS is the same as the optimal lesion site; however, this match has not been investigated previously. We sought to determine whether the location of thalamic DBS matched the site at which thalamotomy would be performed. Eleven patients who had detailed microelectrode recording and stimulation for placement of DBS electrodes and subsequent successful tremor control were analysed. An experienced surgeon, blinded to outcome and final electrode position, selected the ideal thalamotomy site based on the reconstructed maps obtained intraoperatively. When the site of long-term clinically used DBS and theoretical thalamotomy location was calculated in three-dimensional space and compared for each of the x, y, and z axes in stereotactic space, there was no significant difference in the mediolateral location of DBS and theoretical lesion site. There was also no difference between the theoretical lesion site and the placement of the tip of the electrode; however, the active electrodes used for chronic stimulation were significantly more anterior (P = 0.005) and dorsal (P = 0.034) to the ideal thalamotomy target. This mismatch may reflect the compromise required between adverse and beneficial effects with chronic stimulation, but it also suggests different mechanisms of effect of DBS and thalamotomy.
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Affiliation(s)
- Zelma H T Kiss
- Department of Clinical Neurosciences, University of Calgary, Foothills Hospital Calgary Health Region, Calgary, Alberta, Canada.
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Goto S, Kunitoku N, Hamasaki T, Nishikawa S, Ushio Y. Abolition of postapoplectic hemichorea by Vo-complex thalamotomy: long-term follow-up study. Mov Disord 2001; 16:771-4. [PMID: 11481712 DOI: 10.1002/mds.1135] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We report a patient with hemichorea following subthalamic hemorrhage. Vo-complex thalamotomy abolished the choreic movements for over 4 years of follow-up.
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Affiliation(s)
- S Goto
- Department of Neurosurgery, Kumamoto University Medical School, Kumamoto, Japan.
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Muta D, Goto S, Nishikawa S, Hamasaki T, Ushio Y, Inoue N, Mita S. Bilateral pallidal stimulation for idiopathic segmental axial dystonia advanced from Meige syndrome refractory to bilateral thalamotomy. Mov Disord 2001; 16:774-7. [PMID: 11481713 DOI: 10.1002/mds.1122] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Meige syndrome is an adult-onset dystonic movement disorder that predominantly involves facial muscles, while some patients with this syndrome develop spasmodic dysphonia and dystonia of the neck, trunk, arms, and legs. We report that all dystonic symptoms that had been refractory to both pharmacotherapy and bilateral thalamotomy were markedly alleviated by bilateral pallidal stimulation in a patient with segmental axial dystonia advanced from Meige syndrome.
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Affiliation(s)
- D Muta
- Department of Neurosurgery, Kumamoto University Medical School, Kumamoto, Japan
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Kudo M, Goto S, Nishikawa S, Hamasaki T, Soyama N, Ushio Y, Mita S, Hirata Y. Bilateral thalamic stimulation for Holmes' tremor caused by unilateral brainstem lesion. Mov Disord 2001; 16:170-4. [PMID: 11215584 DOI: 10.1002/1531-8257(200101)16:1<170::aid-mds1033>3.0.co;2-p] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- M Kudo
- Department of Neurosurgery, Kumamoto University Medical School, Japan
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