Objective: Case reports.

Background: Although botulinum toxin is routinely used as first-line treatment for focal dystonias, little is known about its usefulness in the treatment of pseudodystonia due to lesions involving the proprioceptive pathways.

Methods: Patient 1: A 36 year-old man with abnormal movements of the left upper limb secondary to a chronic (probably vascular) lesion of the right dorsolateral thalamus. The abnormal movements of the non-functional arm interfered with activities of daily living (ADLs). Examination revealed dystonic postures and choreatic movements, as well as a proprioceptive defect of the affected limb. Patient 2: A 54 year-old man with small vessel left thalamo-capsular stroke presenting with a right sensorimotor deficit and hemiataxia. Despite resolution of hemiparesis, clumsiness and abnormal postures of the right hand persisted, interfering with ADLs. Examination disclosed mild somatosensory and proprioceptive impairment, astereognosis, normal muscle strength, ataxia, mild spasticity and pseudodystonia of the right hand. In both cases, botulinum toxin treatment under ultrasound guidance was proposed to alleviate the pseudodystonia and the associated forearm pain. Botulinum toxin (Botox®, Allergan) was administered using ultrasound guidance in upper limb muscles (3 sessions at 3 month intervals). Doses and pattern of injected muscles were adjusted as needed in subsequent treatments, including both agonist and antagonist muscles. Total dose on last treatment was 305U and 125U for patients 1 and 2, respectively. Patients were assessed using the Goal attainment scaling (GAS) at baseline (P0-pre-treatment) and 6 weeks after the 3^rd treatment (P3).

Results: Both patients reported significant improvement in involuntary movement frequency and severity from P0 to P3, enabling or facilitating ADLs such as writing, dressing, falling asleep and grasping; there was complete relief of pain in both cases. GAS change score (P1 to P3) was 36,5 (patient 1) and 21,7 (patient 2). No significant change in muscle tone was noted between P0 and P3.

Conclusions: Significant functional gains were obtained in these two patients with pseudodystonia, despite the somatosensory nature of their deficits. The authors suggest that botulinum toxin treatment may be a useful treatment option for patients with thalamic pseudodystonia of the upper limbs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/pseudodystonic-upper-limb-secondary-to-thalamic-lesions-usefulness-of-ultrasound-guided-botulinum-toxin-treatment/