Safety and long-term efficacy of ventro-oral thalamotomy for focal hand dystonia

Abstract

ObjectiveTo report the safety and long-term efficacy of ventro-oral thalamotomy for 171 consecutive patients with task-specific focal hand dystonia.MethodsBetween 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.ResultsThe 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.ConclusionVentro-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 evidenceThis study provides Class IV evidence that for patients with task-specific focal hand dystonia, ventro-oral thalamotomy improves dystonia.

Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases

“…The bias can be explained by the excellent results that have been obtained (Doshi et al, 2017). These results are similar to that observed by others (Horisawa et al, 2019).…”

Deep Brain Stimulation and Thalamotomy for the Treatment of Dystonia Acquired by Moyamoya Disease with Stroke

“…Fortunately, this patient developed unilateral symptoms that did not require bilateral procedures since unilateral thalamotomy largely reduced the adverse event risks [15]. Other limitations of thalamotomy include the risk of symptom recurrence, which means the improvement obtained after thalamotomies may diminish over time [3,15]. In this case, the hemorrhagic lesion of the thalamus presented on the presurgical images was located significantly close to and possibly overlapping the VIM/VOA target, indicating that VIM/VOA thalamotomy alone may not produce permanent and satisfactory efficacy.…”

“…On the contrary, thalamotomy produces irreversible lesions and may also carry the risks of possible severe complications [12,13,14]. Fortunately, this patient developed unilateral symptoms that did not require bilateral procedures since unilateral thalamotomy largely reduced the adverse event risks [15]. Other limitations of thalamotomy include the risk of symptom recurrence, which means the improvement obtained after thalamotomies may diminish over time [3,15].…”

Case Report: Deep Cerebellar Stimulation for Tremor and Dystonia

“…The present patient experienced recurrence of left hand tremor 2 years after the first VIM thalamotomy. Recurrence of tremor or dystonia by insufficient ablation or misalignment of the target after thalamotomy usually occurs within 3 months of surgery ( 12 ). Recurrence 2 years after thalamotomy suggests that this recurrence was due to disease progression.…”