Stereotactic Selective Thalamotomy for Focal Dystonia with Aid of Depth Microrecording

Successful treatment of focal hand dystonia after cervical whiplash injury by thalamotomy

Background:

Posttraumatic focal hand dystonia after cervical whiplash injury is rare. Moreover, the treatment of peripheral posttraumatic dystonia is usually ineffective. Herein, we report a case of successful thalamotomy for a patient with focal hand dystonia after cervical whiplash injury.

Case Description:

A 39-year-old woman was hit from behind by a car; subsequently, she felt strange in the right hand and was diagnosed with whiplash injury. A month later, she developed a persistent abnormal posture of the right hand. Brain imaging showed no lesions, and cervical magnetic resonance imaging showed stenosis but no spinal cord signal changes. Posttraumatic dystonia was diagnosed, for which the patient underwent left ventro-oral (Vo) thalamotomy. One year after the first surgery, the patient underwent left Vo and ventral intermediate nucleus (Vim) thalamotomy due to recurrence of dystonia. Nine years after the second surgery, the patient continues to be able to maintain her normal physical routine.

Conclusion:

Vo-Vim thalamotomy may be a feasible and effective treatment for focal hand dystonia after cervical whiplash injury.

[Historical view on the pathogenesis and surgical treatment of cervical dystonia]

In the past few decades, approaches to surgical treatment of dystonia passed through paradigmatic shift. Intradural upper cervical anterior rhizotomy was replaced by selective peripheral denervation with lesser spectrum of side-effects. Such techniques as microvascular decompression of accessory nerve or spinal cord stimulation for cervical dystonia were abandoned due to lack of proven efficacy. Introducing globus pallidus interna (GPi) DBS in 1990's to treat all types of dystonia, including cervical dystonia, was a fundamental factor. With the growing body of knowledge on the pathophysiology of dystonia, GPi DBS appears to be the most expedient, effective and safe method with limited indications to peripheral destructive procedures.