Successful Treatment of Auricular Dystonia by Unilateral Pallidothalamic Tractotomy

Abstract

Background: Ear movement disorders are rarely reported. Although some patients may respond to botulinum toxin injections, reports on surgical treatment options remain limited. Case Report: A 57-year-old woman was diagnosed with auricular dystonia, which was refractory to botulinum toxin injections. Since involuntary movement and pain were predominantly present on the right side and the patient rejected the implantation of a mechanical device, we decided to perform left pallidothalamic tractotomy. Immediately following lesioning, bilateral ear movements and right auricular pain ceased with no complications. Discussion: Stereotactic neurosurgical treatment can be an alternative for auricular dystonia. Highlights: Ear movement disorders, such as auricular myoclonus or dystonia, are rarely reported. The present case was refractory to repetitive botulinum toxin injections and oral medications. To the best of our knowledge, this is the first case of auricular dystonia that successfully improved with stereotactic neurosurgical treatment (pallidothalamic tractotomy).

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

“…considered transiently decreased consciousness after pallidothalamic tractotomy (author called campotomy) resulting from lesion encroachment on the ascending reticular activating system. Other previous and current studies of pallidothalamic tractotomy for dystonia, Huntington's disease, and epilepsy did not report transient somnolence 11,32–35 . Here, only two out of 35 patients had transient somnolence (5.7%).…”

“…Other previous and current studies of pallidothalamic tractotomy for dystonia, Huntington's disease, and epilepsy did not report transient somnolence. 11,[32][33][34][35] Here, only two out of 35 patients had transient somnolence (5.7%).…”

Ear Dyskinesia in the Absence of Neuroleptics: A Case Report

“…These disorders include auricular myoclonus, focal motor seizures, and dystonia [ 8 ]. The anterior, superior, and posterior auricular muscles are the three vestiges around the ear [ 9 ]. Extrinsic scalp muscles can be used by certain people to move their ears, despite the intrinsic musculature of the ear being involuntary [ 10 ].…”

“…Pharmaceutical options such as propranolol, clonazepam, and pregabalin are used as treatment approaches; however, injections of botulinum toxin have been found to be the most successful treatment [ 2 , 11 , 12 ]. Pallidothalamic tractotomy has also been used anecdotally [ 4 , 9 ]. The motions' clinical and electrophysiological features bear similarity to dystonic patterns of muscle contraction [ 13 ].…”