Ventro-Oral Thalamotomy Improves Refractory Focal Hand Dystonia

Closeup shot of an unidentifiable businessman suffering with pain in his hands
Of the 18 patients with recurrent dystonic symptoms, 7 of the 9 who underwent repeat ventro-oral thalamotomy achieved improvement.Of the 18 patients with recurrent dystonic symptoms, 7 of the 9 who underwent repeat ventro-oral thalamotomy achieved improvement.

Results from a study recently published in Neurology suggest that ventro-oral thalamotomy improves refractory task-specific focal hand dystonia.

A total of 171 consecutive patients with task-specific focal hand dystonia who were treated with unilateral ventro-oral thalamotomy between October 2003 and February 2017 were included in the study. The etiologies included in the cohort were writer’s cramp (n=92), musician’s dystonias (n=58), and other occupational task-related dystonias (n=21). To assess each patient’s neurologic conditions, the researchers used the task-specific focal hand dystonia scale, with a range of 1 to 5 points (higher score indicated better neurologic conditions). Scores were determined prior to intervention as well as at 1 week, 3 months, and 12 months following treatment. The researchers also examined the safety of the treatment by analyzing postoperative complications and postoperative recurrence.

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Patients were assessed during a mean clinical follow-up period of 25.4 ± 32.1 months (range: 3-165). Compared with baseline, significant improvements in dystonia occurred at 1 week (1.72 ± 0.57 vs 4.33 ± 0.85, respectively; P <.001), 3 months (4.30 ± 1.06; P <.001]), and 12 months (4.30 ± 1.13; P <.001), and the last follow-up (4.39 ± 1.07; P <.001]). Recurrent dystonic symptoms developed in a total of 18 patients following intervention, and 7 of the 9 patients who underwent repeat ventro-oral thalamotomy achieved improvement. Temporary adverse events occurred in up to 28 patients (16.4%); however, the researchers did not determine whether events were significantly different between each follow-up.

Limitations of the study include its relatively small sample size as well as the lack of a comparator sham control group.

“Although further well-powered studies (prospective, randomized, and double blind) are needed to clarify the safety and efficacy of ventro-oral thalamotomy for task-specific focal hand dystonia,” the investigators concluded, “this study supports our hypothesis that ventro-oral thalamotomy is a feasible and effective treatment for patients with refractory task-specific focal hand dystonia.”


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-e377.