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Dystonia as complication of thalamic neurosurgery.
Parkinsonism Relat Disord 2019; 66:232-236PR

Abstract

BACKGROUND

Thalamotomy and deep brain stimulation of the ventralis intermedius nucleus are effective symptomatic treatments for tremor, irrespective of the underlying diagnosis.

METHODS AND RESULTS

Herein we describe six tremor patients (2 Parkinson's disease, 1 dystonic tremor, 2 Essential tremor plus dystonia, 1 Essential tremor plus ataxia) who underwent thalamic neurosurgery and acutely or sub-acutely developed dystonia that was permanent in three cases and could not be managed with any adjustments in the stimulation settings. Tremor response was excellent. We argue that thalamic procedures disrupted either or both the cerebello-thalamic and the cortico-striato-pallido-thalamo-cortical loop resulting in an increase of the thalamo-cortical outflow and subsequent change in the clinical picture from tremor to dystonia.

CONCLUSION

Thalamic neurosurgery might be rarely complicated by dystonia. Why some patients are more prone to develop this adverse event is still unknown and possibly related to intrinsic factors, which certainly need further studies.

Authors+Show Affiliations

Centre for Neurodegenerative Diseases (CEMAND), Department of Medicine, Surgery and Odontoiatry, Neuroscience Section, University of Salerno, Salerno, Italy.Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK.Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.Centre for Brain Health, Dublin Neurological Institute, National Centre for Deep Brain Stimulation, Mater Misericordiae University Hospital, Dublin, Ireland.Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St George's University of London, London, UK.Toronto Western Hospital, UHN, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.Toronto Western Hospital, UHN, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada.Toronto Western Hospital, UHN, Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada.Centre for Brain Health, Dublin Neurological Institute, National Centre for Deep Brain Stimulation, Mater Misericordiae University Hospital, Dublin, Ireland.Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, ON, Canada. Electronic address: alfonso.fasano@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31434632

Citation

Picillo, Marina, et al. "Dystonia as Complication of Thalamic Neurosurgery." Parkinsonism & Related Disorders, vol. 66, 2019, pp. 232-236.
Picillo M, Paramanandam V, Morgante F, et al. Dystonia as complication of thalamic neurosurgery. Parkinsonism Relat Disord. 2019;66:232-236.
Picillo, M., Paramanandam, V., Morgante, F., Algarni, M., Olszewska, D. A., Munhoz, R. P., ... Fasano, A. (2019). Dystonia as complication of thalamic neurosurgery. Parkinsonism & Related Disorders, 66, pp. 232-236. doi:10.1016/j.parkreldis.2019.08.008.
Picillo M, et al. Dystonia as Complication of Thalamic Neurosurgery. Parkinsonism Relat Disord. 2019;66:232-236. PubMed PMID: 31434632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dystonia as complication of thalamic neurosurgery. AU - Picillo,Marina, AU - Paramanandam,Vijayashankar, AU - Morgante,Francesca, AU - Algarni,Musleh, AU - Olszewska,Diana A, AU - Munhoz,Renato Puppi, AU - Aziz,Tipu, AU - Pereira,Erlick, AU - Hodaie,Mojgan, AU - Kalia,Suneil K, AU - Lozano,Andres M, AU - Lynch,Tim, AU - Fasano,Alfonso, Y1 - 2019/08/14/ PY - 2019/04/09/received PY - 2019/07/01/revised PY - 2019/08/11/accepted PY - 2019/8/23/pubmed PY - 2019/8/23/medline PY - 2019/8/23/entrez KW - DBS KW - Dystonia KW - Stimulation KW - Thalamus KW - Tremor SP - 232 EP - 236 JF - Parkinsonism & related disorders JO - Parkinsonism Relat. Disord. VL - 66 N2 - BACKGROUND: Thalamotomy and deep brain stimulation of the ventralis intermedius nucleus are effective symptomatic treatments for tremor, irrespective of the underlying diagnosis. METHODS AND RESULTS: Herein we describe six tremor patients (2 Parkinson's disease, 1 dystonic tremor, 2 Essential tremor plus dystonia, 1 Essential tremor plus ataxia) who underwent thalamic neurosurgery and acutely or sub-acutely developed dystonia that was permanent in three cases and could not be managed with any adjustments in the stimulation settings. Tremor response was excellent. We argue that thalamic procedures disrupted either or both the cerebello-thalamic and the cortico-striato-pallido-thalamo-cortical loop resulting in an increase of the thalamo-cortical outflow and subsequent change in the clinical picture from tremor to dystonia. CONCLUSION: Thalamic neurosurgery might be rarely complicated by dystonia. Why some patients are more prone to develop this adverse event is still unknown and possibly related to intrinsic factors, which certainly need further studies. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/31434632/Dystonia_as_complication_of_thalamic_neurosurgery L2 - https://linkinghub.elsevier.com/retrieve/pii/S1353-8020(19)30364-5 DB - PRIME DP - Unbound Medicine ER -