Shiro Horisawa1, Shinichi Goto2, Nobuhiko Takeda1, Hanae Terashima1, Takakazu Kawamata1, Takaomi Taira3. 1. Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan. 2. Department of Neurosurgery, Kumamoto Takumadai Rehabilitation Hospital, Kumamoto, Japan. 3. Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: ttaira@nij.twmu.ac.jp.
Abstract
BACKGROUND: We investigated the utility of pallidotomy for cervical dystonia after failed selective peripheral denervation. CASE DESCRIPTION: A 36-year-old man presented with cervical dystonia with limited range of motion of the left shoulder, particularly in abduction. His Tsui score was 8. Owing to the ineffectiveness of botulinum toxin injection, he underwent selective peripheral denervation with an unsatisfactory outcome, with a postoperative Tsui score of 6. Simultaneous bilateral pallidotomy was performed with local anesthesia 1 year after the initial surgery. The day after the pallidotomy, all dystonic symptoms were markedly improved except for the limited range of shoulder abduction. The Tsui score recorded 1 week after the pallidotomy was 1. Transient aggressive behavior was the only postoperative complication. During clinical follow-up period of 1 year, no recurrence of the symptoms was observed. CONCLUSIONS: Pallidotomy represents a feasible and effective treatment for cervical dystonia refractory to selective peripheral denervation without hardware-related complications.
BACKGROUND: We investigated the utility of pallidotomy for cervical dystonia after failed selective peripheral denervation. CASE DESCRIPTION: A 36-year-old man presented with cervical dystonia with limited range of motion of the left shoulder, particularly in abduction. His Tsui score was 8. Owing to the ineffectiveness of botulinum toxin injection, he underwent selective peripheral denervation with an unsatisfactory outcome, with a postoperative Tsui score of 6. Simultaneous bilateral pallidotomy was performed with local anesthesia 1 year after the initial surgery. The day after the pallidotomy, all dystonic symptoms were markedly improved except for the limited range of shoulder abduction. The Tsui score recorded 1 week after the pallidotomy was 1. Transient aggressive behavior was the only postoperative complication. During clinical follow-up period of 1 year, no recurrence of the symptoms was observed. CONCLUSIONS: Pallidotomy represents a feasible and effective treatment for cervical dystonia refractory to selective peripheral denervation without hardware-related complications.
Authors: Liesanne M Centen; D L Marinus Oterdoom; Marina A J Tijssen; Ivon Lesman-Leegte; Martje E van Egmond; J Marc C van Dijk Journal: Mov Disord Date: 2020-11-20 Impact factor: 10.338