Objective: The aim of this systematic review is to summarize published reports on RL for hemidystonia and to evaluate clinical outcome.

Background: Radiofrequency lesioning (RL) has been a mainstay in functional neurosurgery to treat dystonic movement disorders, which was replaced by deep brain stimulation (DBS) in the late 1990s. Studies on RL have shown variable benefit in patients with hemidystonia.

Method: A systematic literature review was performed according to PRISMA guidelines in PubMed, Embase, and Web of Science using a customized software (UiPath, NY) to identify all case reports, case series, and cohort studies reporting patients with hemidystonia treated with RF. Manuscripts were then automatically searched for the search term “hemidystonia”. The selected manuscripts were manually screened to identify appropriate reports.

Results: More than 20 reports were identified with 118 cases published between the years 1962 – 2022. Thalamotomy was performed in 88 cases, pallidotomy in 27 cases, and both in the remaining 3 cases. Until 1998, improvement in hemidystonia was not quantified using standard rating scale. Qualitatively good improvement was reported in 18/39 (50%) patients with hemidystonia after thalamotomy. In addition, newer reports indicated a 35% benefit in BFMDRS total score in 7 patients and 60% in 15 patients, respectively. With respect to pallidotomy, 4/8 (50%) patients for whom individual patient data were available were classified as responders, when considering a 30% cut-off for improvement. The lack of a standardized assessment of the results contributes to the difficulty in interpreting the outcome.

Conclusion: With recent advances in targeting methods, RL may be reconsidered as a treatment option for hemidystonia as an alternative to DBS. Further studies with standardized assessment of outcomes are needed to better characterize variability in outcome and to identify prognostic factors.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/radiofrequency-lesioning-for-hemidystonia-a-systematic-review/