Surgical interventions for task-specific dystonia (writer's dystonia)

Doshi, Paresh K; Ramdasi, Raghvendra; Karkera, Bharati; Kadlas, Dilraj B

doi:10.4103/aian.aian_15_17

Cited by 20 publications

(2 citation statements)

References 23 publications

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“…Contemporary articles have largely centered on the treatment of focal hand dystonia (FHD), a sporadic focal dystonia that usually presents in patients between 30 and 50 years of age, with clinical phenotypes ranging from writer's cramp to dystonia [2]. Approximately 13 out of 16 patients from the five recent studies were treated for FHD, with 11 patients undergoing MRgFUS to the Vo thalamus [33,34], a previously established anatomical target for ablative procedures for FHD [35][36][37]. Additionally, two patients with tremor-dominant writer's cramp underwent ViM thalamotomy (one ViM only and one combined ViM/VO thalamus) [38,39], as ViM is an established anatomical target for tremor [40].…”

Section: Current Evidence For Fus In Dystoniamentioning

confidence: 99%

MRI-Guided Focused Ultrasound for the Treatment of Dystonia: A Narrative Review

Momin,

Aquilina,

Bulstrode

et al. 2024

Cureus

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Contemporary surgical management of dystonia includes neuromodulation via deep brain stimulation (DBS) or ablative techniques such as radiofrequency (RF) ablation. MRI-guided focused ultrasound (MRgFUS) is an emerging modality that uses high-intensity ultrasound to precisely ablate targets in the brain; this is incisionless, potentially avoiding the surgical risks of a burr hole and transcortical tract to reach the anatomical target. There is some evidence of efficacy in essential tremor and Parkinson’s disease (PD), but, to date, there is no study aggregating the evidence of MRgFUS in dystonia. In this narrative review, we searched Medline, Embase, CINAHL, EBSCO, and ClinicalTrials.gov for primary studies and clinical trials on MRgFUS in the treatment of dystonia. Data were analyzed concerning dystonia phenotype, reported outcomes, and complications. PD-related dystonia was also included within the scope of the review. Using our search criteria, six articles on the use of MRgFUS in adult dystonia and three articles on the use of FUS in dystonia in PD were included. Four trials on the use of FUS in dystonia were also found on ClinicalTrials.gov , one of which was completed in December 2013. All included studies showed evidence of symptomatic improvement, mostly in focal hand dystonia; improvements were also found in dystonia-associated tremor, cervicobrachial dystonia, and dystonia-associated chronic neuropathic pain as well as PD-related dystonia. Reported complications included transient neurological deficits and persistent arm pain in one study. However, the evidence is limited to level-4 case series at present. MRgFUS is an emerging modality that appears to be safe and effective, particularly in focal hand dystonia, without major adverse effects. However, the quality of evidence is low at present, and long-term outcomes are unknown. High-quality prospective studies comparing MRgFUS to other surgical techniques will be useful in determining its role in the management of dystonia.

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Section: Current Evidence For Fus In Dystoniamentioning

confidence: 99%

MRI-Guided Focused Ultrasound for the Treatment of Dystonia: A Narrative Review

Momin,

Aquilina,

Bulstrode

et al. 2024

Cureus

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“…Task-specific dystonia (though a focal dystonia) has been excluded from this report as it is subjected to thalamotomy and has been reported previously. 16…”

Section: Patient Selectionmentioning

confidence: 99%

Outcomes of Unilateral Pallidotomy in Focal and Hemidystonia Cases: A Single‐Blind Cohort Study

Doshi,

Baldia,

Mulroy

et al. 2023

Movement Disord Clin Pract

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BackgroundThe role of Deep brain stimulation in the treatment of dystonia has been widely documented. However, there is limited literature on the outcome of lesioning surgery in unilateral dystonia. We present our long‐term experience of lesioning of Globus pallidus internus (GPi) for dystonia.MethodsPatients undergoing radiofrequency lesioning of GPi for unilateral dystonia, between 1999 to 2019 were retrospectively reviewed. All patients were evaluated using the Burke‐Fahn‐Marsden Dystonia rating scale (BFMDRS) and Dystonia Disability scale (DDS) preoperatively, at the short term follow up (<1 year) and at long‐term follow up (2‐7.5 years). Video recordings performed at these time points were independently review by a blinded movement disorders specialists.ResultsEleven patients were included for analysis. The preoperative, short‐term follow‐up and long term follow up motor BFMDRS and DDS were 15.5 (IQR 10.5, 23.75) and 10.5 (IQR 6.0,14.5); 3.0 (IQR 1.0, 6.0, p=0.02) and 3.0 (IQR 3.0, 8.0, p=0.016); and 14.25 (IQR 4.0,20.0, p=.20) and 10.5 (IQR 2.0, 15.0, p=0.71) respectively. For observers B, the BFMDRS scores at the same time points were 19 (IQR 12.5, 27.0), 7.5 (IQR 6.0,15.0 p=0.002) and 21 (IQR 7.0, 22.0, p=0.65) respectively. The improvement was statistically significant for all observations at short term follow up but not at the long term follow up.ConclusionPallidotomy is effective for hemidystonia or focal dystonia, in the short term. Continued benefit was seen in the longer‐term in some patients, whereas others worsened. Larger studies may be able to explain this in future.This article is protected by copyright. All rights reserved.

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Ten‐Year Reflections on the Neurophysiological Abnormalities of Focal Dystonias in Humans

et al. 2019

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The physiological landscape of dystonia has changed considerably over the past 10 years. Initial ideas that dystonic motor symptoms could be explained by a combination of loss of inhibition and increased plasticity, together with subtle deficits in sensory processing, have been questioned, whereas the possible role of the cerebellum has risen in importance. In addition, it has been recognized that symptoms affect more than just the motor and sensory systems and encompass independent cognitive and psychological changes. Finally, it has become clear that, despite similarities in symptoms, there may be pathophysiological differences between idiopathic, inherited, and acquired forms of dystonia. In other words, progress in the pathophysiology of dystonia has followed the usual pattern from an initial phase in which core deficits are readily explained by highly simplified models to a realization that within a highly interconnected network, effects are more nuanced with widespread changes that might either compensate or contribute to the clinical symptoms to different degrees in different individuals. © 2019 International Parkinson and Movement Disorder Society

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Surgical interventions for task-specific dystonia (writer's dystonia)

Cited by 20 publications

References 23 publications

MRI-Guided Focused Ultrasound for the Treatment of Dystonia: A Narrative Review

MRI-Guided Focused Ultrasound for the Treatment of Dystonia: A Narrative Review

Outcomes of Unilateral Pallidotomy in Focal and Hemidystonia Cases: A Single‐Blind Cohort Study

Ten‐Year Reflections on the Neurophysiological Abnormalities of Focal Dystonias in Humans

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