Doshi Paresh K, Ramdasi Raghvendra Vijay, Karkera Bharati, Kadlas Dilraj B
Department of Sterotactic and Functional Neurosurgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
Ann Indian Acad Neurol. 2017 Jul-Sep;20(3):324-327. doi: 10.4103/aian.AIAN_15_17.
Writer's cramp is a focal dystonia producing abnormal postures during selective motor activities. Thalamotomy or globus pallidus internus deep brain stimulation (GPi DBS) has been used as a surgical treatment in patients not responding to medical treatment.
Eight patients (all men, age 16-47 years) with refractory focal hand dystonia underwent either ventrooralis (Vo) thalamotomy (seven patients) or GPi DBS (one patient) using stereotactic techniques. Preoperative video recordings, Writing movment score for dystonic posture and latency of dystonia (WMS), and symptom severity scores (SSSs) were evaluated at baseline and latest follow-up ranging from 1 to 4 years.
All patients had difficulty in performing their most common tasks. The duration of symptoms ranged from 6 months to 12 years. All patients obtained immediate postoperative relief from the dystonic symptoms, and the effect was sustained during the follow-up period. The WMS (range 0-28) improved from a mean of 14.5 before surgery to 2, whereas the SSS (maximum 43 and minimum 10) improved from a mean of 15.3 before surgery to 2 at the last follow-up. There were no surgical complications, morbidity, or mortality.
Vo thalamotomy or GPi DBS offers successful symptom relief in patients with task-specific dystonia.
书写痉挛是一种局灶性肌张力障碍，在选择性运动活动中产生异常姿势。丘脑切开术或苍白球内侧部脑深部电刺激术（GPi DBS）已被用作药物治疗无效患者的外科治疗方法。
8例（均为男性，年龄16 - 47岁）难治性局灶性手部肌张力障碍患者采用立体定向技术接受腹嘴侧丘脑切开术（7例患者）或GPi DBS（1例患者）。在基线以及1至4年的最新随访时评估术前视频记录、肌张力障碍姿势的书写运动评分和肌张力障碍潜伏期（WMS）以及症状严重程度评分（SSS）。
所有患者在执行其最常见任务时均有困难。症状持续时间为6个月至12年。所有患者术后肌张力障碍症状立即缓解，且在随访期间效果持续。WMS（范围0 - 28）从术前平均14.5改善至2，而SSS（最高43，最低10）从术前平均15.3改善至末次随访时的2。无手术并发症、发病率或死亡率。
腹嘴侧丘脑切开术或GPi DBS可为特定任务性肌张力障碍患者成功缓解症状。
