Dysgeusia induced and resolved by focused ultrasound thalamotomy: case report

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  • 1 Division of Neurosurgery, Department of Surgery, Toronto Western Hospital—University Health Network,
  • | 2 Joint Department of Medical Imaging, and
  • | 3 Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada;
  • | 4 Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Vlaams-Brabant, Belgium;
  • | 5 Krembil Research Institute, Toronto, Ontario, Canada;
  • | 6 General Electric Global Research Center, Bangalore, India;
  • | 7 Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and Division of Neurology, University of Toronto, Ontario, Canada; and
  • | 8 Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
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Dysgeusia, or distorted taste, has recently been acknowledged as a complication of thalamic ablation or thalamic deep brain stimulation as a treatment of tremor. In a unique patient, left-sided MR-guided focused ultrasound thalamotomy improved right-sided essential tremor but also induced severe dysgeusia. Although dysgeusia persisted and caused substantial weight loss, tremor slowly relapsed. Therefore, 19 months after the first procedure, the patient underwent a second focused ultrasound thalamotomy procedure, which again improved tremor but also completely resolved the dysgeusia.

On the basis of normative and patient-specific whole-brain tractography, the authors determined the relationship between the thalamotomy lesions and the medial border of the medial lemniscus—a surrogate for the solitariothalamic gustatory fibers—after the first and second focused ultrasound thalamotomy procedures. Both tractography methods suggested partial and complete disruption of the solitariothalamic gustatory fibers after the first and second thalamotomy procedures, respectively.

The tractography findings in this unique patient demonstrate that incomplete and complete disruption of a neural pathway can induce and resolve symptoms, respectively, and serve as the rationale for ablative procedures for neurological and psychiatric disorders.

ABBREVIATIONS

AC = anterior commissure; CRST = Clinical Rating Scale for Tremor; DBS = deep brain stimulation; DWI = diffusion-weighted imaging; ET = essential tremor; FA = fractional anisotropy; ML = medial lemniscus; MNI = Montreal Neurological Institute; MRgFUS = MR-guided focused ultrasound; NTS = nucleus tractus solitarius; PC = posterior commissure; Vim = ventrointermedius of the thalamus; VPMpc = ventroposteromedial nucleus pars parvicellularis.

Illustration from Schneider et al. (pp 205–214). Copyright Elyssa Siegel. Published with permission.

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