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Unilateral pallidotomy in the treatment of cervical dystonia: a retrospective observational study.
J Neurosurg. 2019 Dec 20 [Online ahead of print]JN

Abstract

OBJECTIVE

The objective of this study was to assess the efficacy of unilateral pallidotomy in patients with asymmetrical cervical dystonia.

METHODS

This study retrospectively included 25 consecutive patients with asymmetrical cervical dystonia refractory to botulinum toxin injections, who underwent unilateral pallidotomy between January 2015 and April 2017. Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were evaluated preoperatively and 1 week, 3 months, and 6 months postoperatively. The clinical responses were defined as good responders, exhibiting > 50% improvement in the TWSTRS score at 6 months postsurgery, or poor responders, exhibiting < 50% improvement in TWSTRS scores at 6 months postsurgery.

RESULTS

Twelve and 9 patients showed right- and left-side rotation, respectively; 1 and 3 patients had right- and left-side laterocollis, respectively. The mean age of onset and duration of the disease were 40.2 ± 13.9 and 8.9 ± 10.9 years, respectively. Mean TWSTRS scores were 38.4 ± 12.6 (p < 0.001), 17.3 ± 12.4 (p < 0.001), 19.5 ± 13.4 (p < 0.001), and 20.0 ± 14.7 (p < 0.001), preoperatively and 1 week, 3 months, and 6 months postoperatively, respectively. Fourteen patients (56%) demonstrated > 50% improvement in their TWSTRS total score (mean improvement of TWSTRS total score = 70.5%) 6 months postsurgically. Furthermore, preoperative TWSTRS severity score was a prognostic factor (odds ratio 1.37, 95% confidence interval 1.06-1.78, p = 0.003).

CONCLUSIONS

These results suggest that unilateral pallidotomy is an acceptable treatment option for asymmetrical cervical dystonia. Further investigations with a larger number of cases and longer follow-up period are required to confirm these data.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31860811

Citation

Horisawa, Shiro, et al. "Unilateral Pallidotomy in the Treatment of Cervical Dystonia: a Retrospective Observational Study." Journal of Neurosurgery, 2019, pp. 1-7.
Horisawa S, Fukui A, Kohara K, et al. Unilateral pallidotomy in the treatment of cervical dystonia: a retrospective observational study. J Neurosurg. 2019.
Horisawa, S., Fukui, A., Kohara, K., Kawamata, T., & Taira, T. (2019). Unilateral pallidotomy in the treatment of cervical dystonia: a retrospective observational study. Journal of Neurosurgery, 1-7. https://doi.org/10.3171/2019.9.JNS191202
Horisawa S, et al. Unilateral Pallidotomy in the Treatment of Cervical Dystonia: a Retrospective Observational Study. J Neurosurg. 2019 Dec 20;1-7. PubMed PMID: 31860811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Unilateral pallidotomy in the treatment of cervical dystonia: a retrospective observational study. AU - Horisawa,Shiro, AU - Fukui,Atsushi, AU - Kohara,Kotaro, AU - Kawamata,Takakazu, AU - Taira,Takaomi, Y1 - 2019/12/20/ PY - 2019/04/29/received PY - 2019/09/25/accepted PY - 2019/12/21/entrez PY - 2019/12/21/pubmed PY - 2019/12/21/medline KW - BFMDRS = Burke-Fahn-Marsden Dystonia Rating Scale KW - DBS = deep brain stimulation KW - GPi = globus pallidus internus KW - SCM = sternocleidomastoid muscle KW - TWSTRS = Toronto Western Spasmodic Torticollis Rating Scale KW - VL = ventrolateral KW - VOi = ventro-oral intermediate KW - cervical dystonia KW - functional neurosurgery KW - globus pallidus internus KW - pallidotomy SP - 1 EP - 7 JF - Journal of neurosurgery JO - J. Neurosurg. N2 - OBJECTIVE: The objective of this study was to assess the efficacy of unilateral pallidotomy in patients with asymmetrical cervical dystonia. METHODS: This study retrospectively included 25 consecutive patients with asymmetrical cervical dystonia refractory to botulinum toxin injections, who underwent unilateral pallidotomy between January 2015 and April 2017. Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores were evaluated preoperatively and 1 week, 3 months, and 6 months postoperatively. The clinical responses were defined as good responders, exhibiting > 50% improvement in the TWSTRS score at 6 months postsurgery, or poor responders, exhibiting < 50% improvement in TWSTRS scores at 6 months postsurgery. RESULTS: Twelve and 9 patients showed right- and left-side rotation, respectively; 1 and 3 patients had right- and left-side laterocollis, respectively. The mean age of onset and duration of the disease were 40.2 ± 13.9 and 8.9 ± 10.9 years, respectively. Mean TWSTRS scores were 38.4 ± 12.6 (p < 0.001), 17.3 ± 12.4 (p < 0.001), 19.5 ± 13.4 (p < 0.001), and 20.0 ± 14.7 (p < 0.001), preoperatively and 1 week, 3 months, and 6 months postoperatively, respectively. Fourteen patients (56%) demonstrated > 50% improvement in their TWSTRS total score (mean improvement of TWSTRS total score = 70.5%) 6 months postsurgically. Furthermore, preoperative TWSTRS severity score was a prognostic factor (odds ratio 1.37, 95% confidence interval 1.06-1.78, p = 0.003). CONCLUSIONS: These results suggest that unilateral pallidotomy is an acceptable treatment option for asymmetrical cervical dystonia. Further investigations with a larger number of cases and longer follow-up period are required to confirm these data. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/31860811/Unilateral_pallidotomy_in_the_treatment_of_cervical_dystonia:_a_retrospective_observational_study_ L2 - https://thejns.org/doi/10.3171/2019.9.JNS191202 DB - PRIME DP - Unbound Medicine ER -
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