Objective: to investigate the safety and efficacy of double lesion MRgFUS intervention for treating cervical drug-refractory dystonia based on clinical signs due to the hypothesis about the involvement of the right and left brain in the pathogenesis of the disease [8].

Background: Magnetic Resonance Imaging–Guided Focused Ultrasound thalamotomy (MRgFUS) is approved for treating essential and Parkinson’s tremor with good long-lasting results [2, 3]. MRgFUS lesioning of ventro-oral nucleus for treating focal hand dystonia (FHD) in ten patients and X-Linked dystonia-parkinsonism in three patients by Japan clinical trials findings by Horisawa S., Taira T. et al. showed efficacy [ 4, 5, 6]. Horisawa S., Taira T., et al. demonstrated significant improvement in TWSTRS total scores and BFMDRS neck scores at the 13.9-month follow-up after unilateral pallidothalamic tractotomy [7].

Method: The data of 13 patients with different types of cervical dystonia who underwent double lesion MRgFUS treatment were analyzed retrospectively. We evaluated The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) score and side effects during the treatment and at the last available follow-up period.

Results: Based on their clinical symptoms, we performed double lesion MRgFUS treatment in 13 patients with different types of cervical dystonia (Table 1). The mean clinical follow-up period was 13.3 ± 3.4 months. The mean TWSTRS total scores were 22 [16; 25] preoperatively and 6 [4; 9] at the last available follow-up period (70.6 % [55.6; 76.5] improvement, Wilcoxon paired test p = 0.002). Six patients experienced mild adverse effects, like transient gait impairment persisting at three weeks. Two patients had psychosis completely reversible by antipsychotic quetiapine 25 mg daily for one month.

Conclusion: Based on the current results, MRgFUS has the potential to be effective and safe for cervical dystonia without surgical hardware and stimulation-related risks and complications compared to other methods of stereotactic neurosurgery. More research is needed to understand the variability in outcomes with a larger group of patients and to identify and study stepwise dual-lesion MRgFUS for a more comprehensive treatment of dystonia.

References: 1. Albanese, A., Bhatia, K., Bressman, S., Delong, M., Fahn, S, Fung, V (2013). Phenomenology and classification of dystonia: a consensus update. Mov Disord, 28:863–73. doi: 10.1002/mds.25475
2. Martínez‐Fernández, R., Rodríguez‐Rojas, R., Del Álamo, M. (2018). Focused ultrasound subthalamotomy in patients with asymmetric Parkinson’s disease: a pilot study. Lancet Neurol 2018;17(1):54–63
3. Elias, W., Lipsman, N., Ondo, W. (2016). A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med;375(8):730–739.
4. Horisawa, S., Yamaguchi, T., Abe, K. (2018). A single case of MRI-guided focused ultrasound ventro-oral thalamotomy for musician’s dystonia. J Neurosurg;131(2):384–386
5. Horisawa, S., Yamaguchi, T., Abe, K. (2021). Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Focal Hand Dystonia: A Pilot Study. Mov Disord; Aug;36(8):1955-1959. doi: 10.1002/mds.28613
6. Jamora, R., Chang, W-C., Taira, T. (2021). Transcranial Magnetic Resonance-Guided Focused Ultrasound in X-Linked Dystonia-Parkinsonism. Life (Basel); Apr 26;11(5):392. doi: 10.3390/life11050392
7. Horisawa, S., Kohara, K., Nonaka, T., Fukui, A., Mochizuki, T., Iijima, M., Kawamata, T., Taira, T. (2022), Unilateral pallidothalamic tractotomy at Forel’s field H1 for cervical dystonia. Ann Clin Transl Neurol, 9: 478487. https://doi.org/10.1002/acn3.51532
8. Kaji, R., Bhatia, K., Graybiel, A. (2018). Pathogenesis of dystonia: is it of cerebellar or basal ganglia origin? Journal of Neurology, Neurosurgery & Psychiatry;89:488-492.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/double-lesion-magnetic-resonance-guided-focused-ultrasound-treatment-for-cervical-dystonia-a-pilot-study-of-two-targets-combination-based-on-clinical-symptoms/