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Pallidotomy for Writer's Cramp after Failed Thalamotomy
Shiro Horisawa1, Shinichi Goto, Nobuhiko Takeda
1Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan.
Stereotactic and Functional Neurosurgery
|May 14, 2016
Summary
For writer's cramp, pallidotomy may offer relief when thalamotomy is ineffective. This case study shows unilateral pallidotomy successfully treated persistent dystonic symptoms after repeated thalamotomy.
Area of Science:
- Neurosurgery
- Movement Disorders
- Neurology
Background:
- Writer's cramp is a focal dystonia impacting fine motor skills.
- Stereotactic thalamotomy is a reported treatment, but its efficacy can be limited.
- Pallidotomy for writer's cramp remains largely uninvestigated.
Observation:
- A 22-year-old woman with writer's cramp experienced only temporary relief after two thalamotomies.
- Her dystonic symptoms progressed to involve the proximal upper limb.
- Unilateral pallidotomy was performed 21 months after the second thalamotomy.
Findings:
- The patient showed immediate improvement in dystonic symptoms post-pallidotomy.
- No adverse effects were noted after the unilateral pallidotomy procedure.
- Writer's cramp did not recur during a 1-year follow-up period.
Implications:
- Unilateral pallidotomy presents a potential therapeutic option for writer's cramp refractory to thalamotomy.
- This suggests pallidotomy may be a viable alternative for severe or persistent focal dystonia.
- Further research into pallidotomy for writer's cramp is warranted.
