Focal and Segmented Forms of Dystonia: Surgical Treatment

Tyurnikov V., Markova ., Dobzhanskiy N.

Research Institute of Neurology, Russian Academy of Medical Sciences, Moscow, Russia

 

Introduction. Despite introduction of new methods of dystonia treatment, including therapy with botulotoxin, severe forms of this clinical syndrome can demand surgical treatment.

Material and Methods. Results of surgical treatment of 25 cases with different forms of dystonia were analyzed. There were 21 cases with a focal form (intermittent torticollis) and 4 cases with a segmented form (a combination of intermittent torticollis and blepharospasm). Stereotaxic cryodestruction of a ventrolateral group of thalamic nuclei (VOA, VOP, VIM) was performed. A size of a cryodestruction focus was 8-9 mm.

Results. Considerable improvement was achieved immediately after operation in 78% of cases. Long-term results were indicative of a positive effect in 66% of patients. Pseudobulbar syndrome was a complication, watched in 2 cases after bilateral operations. There were no fatal outcomes.

Conclusion. Surgical treatment eliminates dystonia manifestations; however, it does not deliver from the disease itself. Surgery is limited by a risk of pseudobulbar syndrome, developing after bilateral operations. Taking into account inefficacy of conservative therapy, surgical intervention can be indicated in some cases.