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Treatment of a Patient With Task-Specific Writing Tremor Using Magnetic Resonance-Guided Focused Ultrasound

  • Ying Meng (a1), Suganth Suppiah (a1), Nadia Scantlebury (a1), Nir Lipsman (a1) and Michael L. Schwartz (a1)...

Abstract

Task-specific dystonia is characterized by abnormal repetitive movements or postures in a specific body part that is triggered and ends with a task, such as writing. Failing medications, surgery, specifically disruption of key nuclei in the thalamus, can provide excellent symptomatic relief. Transcranial magnetic resonance (MR)-guided focused ultrasound is an emerging incision-less thermoablation technique. We describe MR-guided focused ultrasound tandem ablation of the ventral intermediate and ventralis oralis posterior nuclei in a 60-year-old patient with writer’s cramp. The clinical improvement was immediate with incremental benefit from the latter lesion, which was sustained at 6 months follow-up.

Traitement d’un patient atteint de tremblement de l’écriture lié à une tâche spécifique en utilisant des ultrasons concentrés guidés par résonnance magnétique. La dystonie relative à une tâche particulière se caractérise par des postures ou des mouvements anormaux et répétitifs qui affectent une partie spécifique du corps. Ces mouvements sont provoqués lors de l’exécution d’une tâche, par exemple l’écriture, et cessent quand cette tâche se conclut. Pour contrer ce trouble moteur, des traitements médicamenteux ainsi que la chirurgie, c’est-à-dire l’ablation d’une partie du noyau central du thalamus, peuvent procurer un très bon soulagement symptomatique. Cela étant, l’utilisation transcrânienne d’ultrasons concentrés guidés par résonnance magnétique constitue une nouvelle technique de thermoablation qui exclut toute forme d’incision. Notre intention est ici de décrire l’ablation consécutive, au moyen d’ultrasons concentrés guidés par résonnance magnétique, des noyaux ventral médian et oral postérieur dans le cas d’un patient âgé de 60 ans aux prises avec des crampes liées à l’écriture. Si l’amélioration clinique s’est révélée rapide, les bénéfices encourus se sont également révélés durables lors d’un suivi six mois après l’intervention.

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Copyright

Corresponding author

Correspondence to: Y. Meng, Sunnybrook Health Sciences Center, 2075 Bayview Avenue, Toronto, ON, Canada. Email: ying.meng@medportal.ca

References

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7. Fasano, A, Llinas, M, Munhoz, RP, Hlasny, E, Kucharczyk, W, Lozano, AM. MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes. Neurology. 2017;89(8):771-775.
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10. Huss, DS, Dallapiazza, RF, Shah, BB, Harrison, MB, Diamond, J, Elias, WJ. Functional assessment and quality of life in essential tremor with bilateral or unilateral DBS and focused ultrasound thalamotomy. Mov Disord Off J Mov Disord Soc. 2015;30(14):1937-1943.

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Treatment of a Patient With Task-Specific Writing Tremor Using Magnetic Resonance-Guided Focused Ultrasound

  • Ying Meng (a1), Suganth Suppiah (a1), Nadia Scantlebury (a1), Nir Lipsman (a1) and Michael L. Schwartz (a1)...

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