Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia

Horisawa, Shiro; Fukui, Atsushi; Takeda, Nobuhiko; Kawamata, Takakazu; Taira, Takaomi

doi:10.1002/acn3.51333

Cited by 21 publications

(34 citation statements)

References 42 publications

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“…We have previously reported that unilateral pallidotomy significantly improved cervical dystonia with a 47.9% reduction in TWSTRS total score at the 6‐month postoperative evaluation 37 . Additionally, a recent study has shown that bilateral and unilateral pallidotomies improved cervical dystonia with 73% and 50% reduction on the neck subscale of BFMDRS, respectively 27 . The STN is also an available target of DBS for cervical dystonia in a limited number of studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, the possible adverse effects of pallidotomy or pallidothalamic tractotomy are different because of the surrounding structures. In 69 patients with dystonia who underwent unilateral pallidotomy, delayed cerebral infarction at the PLIC in three patients (4.4%), hemiparesis in two patients (2.9%), and visual disturbance in one patient (1.4%) were reported 27 . These complications were strongly associated with injury to adjacent structures of the GPi, including the PLIC (medial to GPi) leading to hemiparesis and optic tract (caudal to GPi) leading to visual field disturbance.…”

Section: Discussionmentioning

confidence: 99%

“…In 69 patients with dystonia who underwent unilateral pallidotomy, delayed cerebral infarction at the PLIC in three patients (4.4%), hemiparesis in two patients (2.9%), and visual disturbance in one patient (1.4%) were reported. 27 These complications were strongly associated with injury to adjacent structures of the GPi, including the PLIC (medial to GPi) leading to hemiparesis and optic tract (caudal to GPi) leading to visual field disturbance. Parkinsonism, including bradykinesia, gait disorder, micrographia, and other parkinsonian motor disturbances, excluding tremor and rigidity, have been reported as stimulating adverse events in GPi-DBS.…”

Section: Discussionmentioning

confidence: 99%

“…37 Additionally, a recent study has shown that bilateral and unilateral pallidotomies improved cervical dystonia with 73% and 50% reduction on the neck subscale of BFMDRS, respectively. 27 The STN is also an available target of DBS for cervical dystonia in a limited number of studies. The reported efficacy varies from 22.8% to 63.9% improvement in TWSTRS total score.…”

Section: Discussionmentioning

confidence: 99%

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Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Horisawa

Kohara

Nonaka

et al. 2022

Ann Clin Transl Neurol

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Background Neurosurgical ablation of Forel's field H1 for cervical dystonia, which is currently abandoned, was formerly used in the 1960s–1970s. Regardless of the lack of neuroimaging modalities and objective evaluation scales, the reported efficacy was significant. Although recent studies have reappraised the ablation of the pallidothalamic tract at Forel's field H1 for Parkinson's disease, the efficacy for cervical dystonia has not been investigated well. Methods Data of 35 patients with cervical dystonia who underwent unilateral pallidothalamic tractotomy at Forel's field H1 were retrospectively analyzed. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores, the neck score of the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), and adverse events were evaluated preoperatively and at the last available follow‐up period. Results The mean clinical follow‐up period was 13.9 ± 6.5 months. The mean TWSTRS total scores were 34.3 ± 14.0 preoperatively and 18.4 ± 16.5 at the last available follow‐up period (46.4% improvement, p < 0.0001). The BFMDRS neck score also improved significantly from 6.2 ± 2.9 preoperatively to 2.8 ± 2.8 at the last available follow‐up period (55.0% improvement on the neck score, p < 0.0001). Reduced hand dexterity in seven patients, hypophonia in five patients, dysarthria in four patients, and executive dysfunction in one patient were confirmed as adverse events at the last available follow‐up evaluation. One patient had postoperative hemorrhage. Conclusion The current study confirmed significant improvement in TWSTRS total scores and BFMDRS neck scores at the 13.9‐month follow‐up after unilateral pallidothalamic tractotomy. The pallidothalamic tract in Forel's field H1 is expected to be an alternative treatment target for cervical dystonia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Horisawa

Kohara

Nonaka

et al. 2022

Ann Clin Transl Neurol

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“…We have performed several neurosurgical treatments for dystonia, including selective peripheral denervation, deep brain stimulation (DBS), and ablative surgeries using radiofrequency, gamma knife, and focused ultrasound ( 14 – 19 ). All surgical candidates in those reports were refractory to conventional oral medications including trihexyphenidyl, clonazepam, and baclofen.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Zolpidem for Focal Dystonia After Neurosurgical Treatments: A Retrospective Cohort Study

et al. 2022

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Although there are several reports of the significant efficacy of zolpidem for treating dystonia, zolpidem is still considered an anecdotal treatment. Here, we evaluated the efficacy and safety of zolpidem for treating residual dystonia in patients who previously received various neurosurgical treatments majorly including deep brain stimulation and radiofrequency ablation. We retrospectively reviewed medical records from January 2021 to September 2021 to identify patients with dystonia who had been prescribed zolpidem after undergoing neurosurgery. Twenty patients were enrolled in this study, including those with blepharospasm (two), tongue dystonia (four), mouth dystonia (one), spasmodic dysphonia (two), cervical dystonia (six), focal hand dystonia (three), hemidystonia (two), blepharospasm with cervical dystonia (one), and mouth dystonia with cervical dystonia (one). Single doses of zolpidem ranged between 2.5 and 10 mg, while daily dosages ranged from 10 to 30 mg. The zolpidem dose prescribed was 5–10 mg, with single and daily doses of 7 ± 2.9 and 14.5 ± 6.0 mg, respectively. With zolpidem administration, the participants' Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale score significantly improved from 8.1 ± 6.7 to 3.7 ± 2.5 (50.6% improvement, p < 0.0001). Improvements in arm dystonia, blepharospasm, and spasmodic dysphonia were observed using the Arm Dystonia Disability Scale, Jankovic Rating Scale, and Voice Handicap Index, respectively. No improvements were observed in cervical dystonia on the Toronto Western Spasmodic Torticollis Rating Scale. Drowsiness, including three cases each of mild and moderate drowsiness, was the most frequent adverse effect (30%), which persisted for 2–3 h. Transient amnesia and rapid eye movement sleep behavior disorder occurred in two patients and one patient, respectively. Although our findings suggest that zolpidem can be a valuable treatment option for patients with residual dystonia after neurosurgical treatments, the beneficial effects for cervical dystonia were limited.

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Improvement of obsessive–compulsive disorder after pallidothalamic tractotomy for cervical dystonia

Horisawa

Kamba

Sato

et al. 2023

Ann Clin Transl Neurol

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A 30-year-old woman with tardive dystonia in the cervical region from longterm antipsychotic meds was treated with radiofrequency ablation of the right pallidothalamic tract in the fields of Forel. The patient showed improvement in both cervical dystonia and obsessive-compulsive disorder after the procedure, with 77.4% improvement in cervical dystonia and 86.7% improvement in obsessive-compulsive disorder. Although the treatment site in this case was intended to treat cervical dystonia, the lesion was located in the optimal stimulation network for both obsessive-compulsive disorder and cervical dystonia, suggesting that neuromodulation of this region could potentially treat both simultaneously.

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Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia

Cited by 21 publications

References 42 publications

Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Efficacy and Safety of Zolpidem for Focal Dystonia After Neurosurgical Treatments: A Retrospective Cohort Study

Improvement of obsessive–compulsive disorder after pallidothalamic tractotomy for cervical dystonia

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