A single case of MRI-guided focused ultrasound ventro-oral thalamotomy for musician’s dystonia

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Musician’s dystonia (MD) is a type of focal hand dystonia that develops only while playing musical instruments and interferes with skilled and fine movements. Lesioning of the ventro-oral (Vo) nucleus of the thalamus (Vo-thalamotomy) using radiofrequency can cause dramatic improvement in MD symptoms. Focused ultrasound (FUS) can make intracranial focal lesions without an incision. The authors used MRI-guided FUS (MRgFUS) to create a lesion on the Vo nucleus to treat a patient with MD. Tubiana’s MD scale (TMDS) was used to evaluate the condition of musical play ranging from 1 to 5 (1: worst, 5: best). The patient was a 35-year-old right-handed man with involuntary flexion of the right second, third, and fourth fingers, which occurred while playing a classical guitar. Immediately after therapeutic sonications of FUS Vo-thalamotomy, there was dramatic improvement in the MD symptoms. The TMDS scores before; at 0 and 1 week after; and at 1, 3, 6, and 12 months after MRgFUS Vo-thalamotomy were 1, 4, 4, 5, 5, 5, and 5, respectively. No complications were observed. Focused ultrasound Vo-thalamotomy can be an effective treatment for MD.

ABBREVIATIONS FUS = focused ultrasound; GKT = Gamma Knife thalamotomy; MD = musician’s dystonia; MRgFUS = MRI-guided FUS; TMDS = Tubiana’s MD scale; Vo = ventro-oral; Vo-thalamotomy = lesioning of the Vo nucleus of the thalamus.

Article Information

Correspondence Takaomi Taira: Tokyo Women’s Medical University, Tokyo, Japan. ttaira@twmu.ac.jp.

INCLUDE WHEN CITING Published online September 21, 2018; DOI: 10.3171/2018.5.JNS173125.

Disclosures Dr. Taira has received lecture fees from Insightec Ltd.

© AANS, except where prohibited by US copyright law.

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    Pre- and postoperative neurological conditions and MRI studies. Involuntary flexion of the right second, third, and fourth fingers while playing a guitar (A). Fluctuation in symptoms was carefully assessed with an MRI-compatible guitar (B). One week after MRgFUS Vo-thalamotomy, improvement in MD symptoms was seen (C). Coronal T2-weighted MR image at 0 (D), 3 (E), and 12 (F) months after MRgFUS Vo-thalamotomy. The lesion at 12 months is still visible. Figure is available in color online only.

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