Thalamotomy with focused ultrasound in the treatment of musician’s dystonia

Background. Approximately from 0.5 to 8 % professional musicians may suffer from focal dystonia. Stereotactic surgery is option if conservative therapy is failed. Thalamotomy has been reported in limited series in the world literature.

Aim. To demonstrate a clinical case of thalamotomy with focused ultrasound in a professional guitarist with focal dystonia of the hand.

Materials and methods. A 40‑year‑old patient suffered from spasms of the fingers while playing the guitar since 2009. Patient lost professional skills and changed his activities due to progression and severity of disease. He visited our clinic for surgical treatment, stereotactic ventro‑oral thalamotomy by transcranial focused ultrasound was considered.

Results. Thalamotomy provided complete reduction of dystonia without complications. On the 2nd day after the procedure, the patient discharged. In a week mild dysarthria was noticed, which did not affect daily activities and completely regressed within a month. A month later, the patient was able to return to concert performance. The follow‑up period was 6 months with no symptoms of the disease.

Conclusion. Successful clinical case of focused ultrasound thalamotomy in patient with musician’s dystonia is presented.

1. Stahl C., Frucht S. Focal task specific dystonia: a review and update. J Neurol 2016;264(7):1536–41. DOI: 10.1007/s00415016-8373-z

2. Likhachev S.A., Chernukha T.N., Lushchik A.V. A rare form of dystonia – a musician’s spasm. Nervnye bolezny = Neurological Disoders 2016;1:48–52. (In Russ.).

3. Jankovic J., Ashoori A. Movement disorders in musicians. Mov Disord 2008;23(14):1957–65. DOI: 10.1002/mds.22255

4. Schuele S., Lederman R. Long-term outcome of focal dystonia in string instrumentalists. Mov Disord 2004;19(1):43–8. DOI: 10.1002/mds.10647

5. Horisawa S., Taira T., Goto S. et al. Long-term improvement of musician’s dystonia after stereotactic ventro-oral thalamotomy. Ann Neurol 2013;74(5):648–54. DOI: 10.1002/ana.23877

6. Taira T., Harashima S., Hori T. Neurosurgical treatment for writer’s cramp. Acta Neurochir Suppl 2003;87:129–31. DOI: 10.1007/978-3-7091-6081-7_27

7. Tubiana R., Chamagne P. [Occupational arm ailments in musicians (In French)]. Bull Acad Natl Med 1993;177(2):203–12; discussion 212–6.

8. Horisawa S., Taira T., Goto S. et al. Long-term improvement of musician’s dystonia after stereotactic ventro-oral thalamotomy. Ann Neurol 2013;74(5):648–54. DOI: 10.1002/ana.23877

9. Horisawa S., Goto S., Nakajima T. et al. Bilateral stereotactic thalamotomy for bilateral musician’s hand dystonia. World Neurosurg 2016;92:585.e21–585.e25. DOI: 10.1016/j.wneu.2016.05.017

10. Horisawa S., Tamura N., Hayashi M. et al. Gamma knife ventrooral thalamotomy for musician’s dystonia. Mov Disord 2016;32(1):89–90. DOI: 10.1002/mds.26726

11. Asahi T., Taira T., Ikeda K. et al. Full recovery from drummer’s dystonia with foot and arm symptoms after stereotactic ventro-oral thalamotomy: a case report. Acta Neurochir (Wien) 2018;160(4):835–8. DOI: 10.1007/s00701-018-3480-5

12. Horisawa S., Ochiai T., Goto S. et al. Safety and long-term efficacy of ventro-oral thalamotomy for focal hand dystonia: a retrospective study of 171 patients. Neurology 2019;92(4):e371–e7. DOI: 10.1212/WNL.0000000000006818

13. Horisawa S., Yamaguchi T., Abe K. et al. Magnetic resonance‐guided focused ultrasound thalamotomy for focal hand dystonia: a pilot study. Mov Disord 2021;36(8):1955–9. DOI: 10.1002/mds.28613

14. Fukaya C., Katayama Y., Kano T et al. Thalamic deep brain stimulation for writer’s cramp. J Neurosurg 2007;107(5):977–82. DOI: 10.3171/JNS-07/11/0977

15. Cho C., Park H., Lee K., Rha H.K. Thalamic deep brain stimulation for writer’s cramp. J Korean Neurosurg Soc 2009;46(1):52–5. DOI: 10.3340/jkns.2009.46.1.52

16. Elias W., Lipsman N., Ondo W. et al. A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 2016;375(8):730–9. DOI: 10.1056/NEJMoa1600159