Movement disorders clinical practice · 2025
Pallidothalamic Tractotomy after Pallidotomy for Medication-Refractory Dystonia: Preliminary Short-Term Results from a Case Series of Five Patients.
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Garg Divyani, Das Animesh, Adhya Arnab, Radhakrishnan Divya M, Rajan Roopa, Elavarasi Arunmozhimaran, Thoibisana Ashem, Garg Ajay, Srivastava Achal Kumar, Singh Manmohan, Chandra P Sarat, Garg Kanwaljeet
Аннотация
BACKGROUND: There is limited data regarding the role of pallidothalamic tract (PTT) lesioning after failure of pallidotomy.
OBJECTIVES: To report the role of unilateral PTT lesioning in refractory generalized dystonia following bilateral pallidotomy and hemi-dystonia following unilateral pallidotomy.
METHODS: A single-center retrospective case series.
RESULTS: Five patients underwent unilateral PTT lesioning after the failure of pallidotomy to control dystonia, including status dystonicus in one case. The interval between pallidotomy and PTT lesioning ranged from 2 to 90 months. Pre-PTT surgery, BFMDRS-M scores ranged from 20 to 87, and BFMDRS-D scores ranged from 8 to 23. Immediately post-PTT surgery, improvement was observed in four patients, with objective improvements ranging between 57.5 and 93.3% in the BFMDRS-M score. Two patients developed adverse effects: one experienced a mild worsening of post-pallidotomy dysarthria, and another developed impaired hand dexterity.
CONCLUSIONS: Our initial experience suggests that unilateral PTT lesioning holds promise as an option for lesional surgery following pallidotomy, in refractory dystonia.
OBJECTIVES: To report the role of unilateral PTT lesioning in refractory generalized dystonia following bilateral pallidotomy and hemi-dystonia following unilateral pallidotomy.
METHODS: A single-center retrospective case series.
RESULTS: Five patients underwent unilateral PTT lesioning after the failure of pallidotomy to control dystonia, including status dystonicus in one case. The interval between pallidotomy and PTT lesioning ranged from 2 to 90 months. Pre-PTT surgery, BFMDRS-M scores ranged from 20 to 87, and BFMDRS-D scores ranged from 8 to 23. Immediately post-PTT surgery, improvement was observed in four patients, with objective improvements ranging between 57.5 and 93.3% in the BFMDRS-M score. Two patients developed adverse effects: one experienced a mild worsening of post-pallidotomy dysarthria, and another developed impaired hand dexterity.
CONCLUSIONS: Our initial experience suggests that unilateral PTT lesioning holds promise as an option for lesional surgery following pallidotomy, in refractory dystonia.