Unilateral pallidotomy in the treatment of cervical dystonia: a retrospective observational study

Fukui

Takeda

et al. 2021

Ann Clin Transl Neurol

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Objective Ablation of the globus pallidus internus (pallidotomy) is an effective surgical intervention for dystonia. However, the current literature on the efficacy and safety of pallidotomy for dystonia is derived only from single‐case reports and small cohort studies. Methods We retrospectively analyzed patients with primary dystonia who underwent pallidotomy at our institution between 2014 and 2019. Neurological conditions were evaluated using the Burke‐Fahn‐Marsden Dystonia Rating Scale (BFMDRS, range: 0–120). We evaluated the total BFMDRS score and each subitem score (nine body regions) in the patients who underwent unilateral and bilateral pallidotomy before surgery and at last available follow‐up. Moreover, postoperative complications were analyzed. Results We found that 69 and 20 patients underwent unilateral and bilateral pallidotomy respectively. The mean age at dystonia onset was 40.4 ± 15.2 years. The mean clinical follow‐up period was 17.2 ± 11.6 months. Unilateral pallidotomy significantly improved the total BFMDRS score from 11.2 ± 14.7 preoperatively to 5.4 ± 7.6 at last available follow‐up (51.8% improvement, p < 0.001). Furthermore, there was a significant and independent improvement in all midline BFMDRS subitems, including eyes, mouth, speech/swallow, and neck, after unilateral pallidotomy. Bilateral pallidotomy significantly improved the total BFMDRS score from 14.6 ± 10.2 preoperatively to 3.8 ± 8.2 at last available follow‐up (74.0% improvement, p < 0.001). However, bilateral pallidotomy induced medically refractory parkinsonism (postural instability and gait disturbance) in five patients, dysarthria in three patients, and dysphagia in one patient. Interpretation Unilateral radiofrequency pallidotomy remains a viable treatment option for patients with some forms of dystonia. Bilateral pallidotomy cannot be recommended due to unacceptably high complication rates.

Section: Discussionmentioning

confidence: 99%

“…Detailed information regarding the pallidotomy procedure has been described in previous articles. 17…”

Section: Surgical Proceduresmentioning

confidence: 99%

Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia

Fukui

Takeda

et al. 2021

Ann Clin Transl Neurol

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“…Dystonia in the craniocervical region including blepharospasm, tongue protrusion dystonia, or cervical dystonia usually require bilateral surgical interventions. However, previous studies reported on some patients with craniocervical dystonia who responded successfully to unilateral surgical intervention [ 15 16 17 18 19 ]. Bilateral ablative procedures are associated with risks of possible complications including dysarthria, dysphagia, and dysphonia.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Auricular Dystonia by Unilateral Pallidothalamic Tractotomy

Kim

Tremor and Other Hyperkinetic Movements

Kohara

et al. 2021

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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).

“…For detailed information about the pallidotomy and pallidothalamic tractotomy procedures, please refer to our previous reports. 8,9 Patient 2…”

Section: Patientmentioning

confidence: 99%

“…At the 2‐year follow‐up, his dystonic symptoms were stable and no significant postoperative complications were found. For detailed information about the pallidotomy and pallidothalamic tractotomy procedures, please refer to our previous reports 8,9 …”

Section: Case Reportsmentioning

confidence: 99%

Radiofrequency ablation for DYT‐28 dystonia: short term follow‐up of three adult cases

Azuma

Akagawa

et al. 2020

Ann Clin Transl Neurol

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Mutations in the lysine methyltransferase 2B (KMT2B) gene have recently been reported to be associated with childhood-onset generalized dystonia. There have been no studies investigating ablative treatments for the management of this disorder. Three patients underwent either a staged unilateral pallidotomy and contralateral pallidothalamic tractotomy (19-year-old man, 2-year follow-up), a unilateral pallidothalamic tractotomy (34-year-old man, 6-month follow-up) or a simultaneous unilateral pallidothalamic tractotomy and ventro-oral thalamotomy (29-year-old man, 6-month follow-up). The average total patient score on the Burke-Fahn-Marsden Dystonia Rating Scale-Movement Scale improved from 39.5 to 13.2 (66.6%) after the procedures. No significant complications were identified. Ablative treatments appear to be a promising alternative surgical option for generalized dystonia with KMT2B mutation.