Magnetic Resonance‐Guided Focused Ultrasound Thalamotomy for Focal Hand Dystonia: A Pilot Study

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 AE 2.7, 1.4 AE 0.5, and 58.7% AE 14.3% at baseline to 1.6 AE 3.1 (P = 0.011), 5.0 AE 0 (P = 0.0001), and 81.6% AE 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.

MRI-guided Focused Ultrasound Neuromodulation, Review Article

“…Simultaneously, tremors and disabilities improved (27). MRI-guided Low-Intensity Focused Ultrasound improves focused hand dystonia (28). Focused Ultrasound thalamotomy reduced MS tremors (29,30).…”

Clinical features, pathophysiology, treatment, and controversies of tremor in dystonia

“…The efficacy of this modality had been tested in few early studies. Magnetic resonance guided focused ultrasound thalamotomy had shown improvement in dystonia in 10 patients with focal hand dystonia [42]. The focus ultrasound of pallidothalamic tract (Forel's field H1-otomy) was effective in treatment of dystonia [43].…”

Update in the clinical application of focused ultrasound

“…On the basis of the experience with radiofrequency ventro-oral thalamotomy for focal dystonia [51], this approach has also been investigated with MRgFUS [52 ▪▪ ]. In a pilot study with 10 patients, MRgFUS thalamotomy reduced writer's cramp dystonia by 71% at 12 months, and dystonia-related disability improved significantly after treatment.…”