Stereotactic Thalamotomy for Task-Specific Dystonia

Abstract

View Supplementary Videos 1, 2. Background: Task-specific dystonia (TSD) is a focal dystonia producing abnormal posture of the fingers or the hand, occurring during selective motor activities that involve repeated use. Conventional medical management and botulinum toxin fail to provide relief in all patients. Thalamotomy or DBS have been used as surgical treatment in patients not responding to medical treatment. Methods: Five patients (all male; age, 18–47 years) with refractory focal hand dystonia underwent ventrooralis (Vo) thalamotomy using stereotactic techniques. Preoperative video recordings, Writer's Cramp Rating Scale (WCRS), and Symptom Severity Scores (SSS) were evaluated at the baseline and at a follow-up date, which ranged between 8 and 44 months (average, 26 months). Results: All the patients had difficulty in performing their most common tasks. Duration of symptoms ranged from 6 months to 12 years. All patients obtained immediate postoperative relief from dystonic symptoms, and the effect was sustained during the follow up period. The WCRS improved from a mean of 20.4 before surgery to a mean of 2.4 at the last follow-up, whereas the SSS improved from a mean of 29.8 before surgery to a mean of 12 at the last follow-up. All patients were able to carry out their specific task with little or no difficulty. There were no surgical complications, morbidity, or mortality. Conclusions: Vo thalamotomy is a safe and effective procedure providing successful symptom relief in patients of TSD.