From the Department of Neurosurgery (S.H., S.G., N.T., A.F., T.K., T.T.), Neurological Institute, Tokyo Women's Medical University; Ochiai Brain Clinic (T.O.), Saitama; Department of Neurosurgery (T.N.), Jichi Medical University, Tochigi; and Department of Neurosurgery (T.H.), Kagoshima University, Japan.
Neurology. 2019 Jan 22;92(4):e371-e377. doi: 10.1212/WNL.0000000000006818. Epub 2018 Dec 26.
To report the safety and long-term efficacy of ventro-oral thalamotomy for 171 consecutive patients with task-specific focal hand dystonia.
Between October 2003 and February 2017, 171 consecutive patients with task-specific focal hand dystonia underwent unilateral ventro-oral thalamotomy. Etiologies included writer's cramps (n = 92), musician's dystonias (n = 58), and other occupational task-related dystonias (n = 21). The task-specific focal hand dystonia scale was used to evaluate patients' neurologic conditions (range 1-5, high score indicated a better condition). The scores before surgery; at 1 week, 3 months, and 12 months postoperatively; and the last available follow-up period were determined. Postoperative complications and postoperative recurrence were also evaluated.
The scores before surgery; at 1 week (1.72 ± 0.57, 4.33 ± 0.85 [ < 0.001]), 3 months (4.30 ± 1.06 [ < 0.001]), and 12 months (4.30 ± 1.13 [ < 0.001]); and the last available follow-up (4.39 ± 1.07 [ < 0.001]) postoperatively improved. The mean clinical follow-up period was 25.4 ± 32.1 months (range: 3-165). Permanent adverse events developed in 6 patients (3.5%). Eighteen patients developed recurrent dystonic symptoms postoperatively. Of these 18 patients, 9 underwent ventro-oral thalamotomy again, of which 7 achieved improvement.
Ventro-oral thalamotomy is a feasible and reasonable treatment for patients with refractory task-specific focal hand dystonias. Prospective, randomized, and blinded studies are warranted to clarify more accurate assessment of the safety and efficacy of ventro-oral thalamotomy for task-specific focal hand dystonia.
This study provides Class IV evidence that for patients with task-specific focal hand dystonia, ventro-oral thalamotomy improves dystonia.
报告 171 例特发性局灶性手部运动障碍患者接受口侧腹侧丘脑切开术的安全性和长期疗效。
2003 年 10 月至 2017 年 2 月，171 例特发性局灶性手部运动障碍患者接受单侧口侧腹侧丘脑切开术。病因包括书写痉挛（n = 92）、音乐家手痉挛（n = 58）和其他职业相关手部运动障碍（n = 21）。采用特发性局灶性手部运动障碍量表评估患者的神经状况（范围 1-5，高分表示病情较好）。评估手术前、术后 1 周、3 个月和 12 个月以及最后一次随访时的评分。还评估了术后并发症和术后复发情况。
手术前、术后 1 周（1.72 ± 0.57，4.33 ± 0.85 [ < 0.001]）、3 个月（4.30 ± 1.06 [ < 0.001]）和 12 个月（4.30 ± 1.13 [ < 0.001]）和最后一次随访时（4.39 ± 1.07 [ < 0.001]）的评分均有所改善。平均临床随访时间为 25.4 ± 32.1 个月（范围：3-165）。6 例患者（3.5%）出现永久性不良事件。18 例患者术后出现复发性运动障碍症状。其中 18 例患者再次接受口侧腹侧丘脑切开术，其中 7 例患者症状改善。
口侧腹侧丘脑切开术是治疗难治性特发性局灶性手部运动障碍的一种可行且合理的方法。需要前瞻性、随机、盲法研究来更准确地评估口侧腹侧丘脑切开术治疗特发性局灶性手部运动障碍的安全性和疗效。
本研究提供了 IV 级证据，证明对于特发性局灶性手部运动障碍患者，口侧腹侧丘脑切开术可改善运动障碍。
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