Hand Dystonia after Focused Ultrasound Thalamotomy in Essential Tremor

Article Article scientifique Rapport de cas Hand Dystonia after Focused Ultrasound Thalamotomy in Essential Tremor eng 2024-06-04 2024 author Cuony Johanna Department of Neurology, Geneva University Hospital, Geneva, Switzerland. 725695 author Lorton Orane Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland.,Image Guided Interventions Laboratory, University of Geneva, Geneva, Switzerland. 855324 author Tomkova Chaoui Emilie Department of Neurology, Geneva University Hospital, Geneva, Switzerland. author Comet Camille Department of Neurology, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium. author Schaller Karl Lothard Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland. 658606 Département des neurosciences cliniques (OTONO) author Salomir Rares Vincent Image Guided Interventions Laboratory, University of Geneva, Geneva, Switzerland.,Division of Radiology, Geneva University Hospital, Geneva, Switzerland. 682178 Département de radiologie et informatique médicale (RADIO) author Momjian Shahan Marc Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland. 84022 Département des neurosciences cliniques (OTONO) author Fleury Vanessa Department of Neurology, Geneva University Hospital, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland. 840771 Département des neurosciences cliniques (OTONO) 203-208 10.1159/000538931 38834047 1011-6125 https://karger.com/article/doi/10.1159/000538931 Introduction: Magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for drug-resistant tremor. The most frequent side effects are ataxia, gait disturbance, paresthesias, dysgeusia, and hemiparesis. Here, we report the first case of thalamic hand dystonia rapidly occurring after MRgFUS thalamotomy of the ventral intermediate nucleus (V.im). Case presentation: MRgFUS thalamotomy was performed in a 60-year-old left-handed patient for his disabling medically refractory essential tremor. The intervention resulted in a marked reduction of his action tremor. However, the patient developed an unvoluntary abnormal posture in his left hand a few days after the procedure with difficulty holding a cigarette between his fingers. Brain MRI revealed the expected MRgFUS lesion within the right V.im as well as an extension of the lesion anteriorly to the V.im in the ventro-oralis nucleus. Tractography showed that the lesion disrupted the dentato-rubro-thalamic tract as expected with a lesion suppressing tremor. However, the lesion also was interrupted fibers connecting to the superior frontal and pre-central cortices (primary motor cortex, premotor cortex, and supplementary area). We hypothesized that the interventional MRgFUS thalamotomy was slightly off target, which induced a dysfunction within the cortico-striato-thalamo-cortical network and the cerebello-thalamo-cortical pathway reaching a sufficient threshold of basal ganglia/cerebellum circuitry interference to induce dystonia. Conclusion: This rare side effect emphasizes the risk of imbalance within the dystonia network (i.e., basal ganglia-cerebello-thalamo-cortical circuit) secondary to V.im thalamotomy. Dystonia Essential tremor MRI-guided high intensity focused ultrasound Side effect Thalamotomy Dewey 616.8 Dewey 616.0757 61 Département des neurosciences cliniques 226 62 Département de radiologie et informatique médicale 227 false 513 Groupe Schaller Karl Lothard (neurochirurgie) 851 926 Imagerie per-opératoire multi-modalité en radiologie interventionnelle 949 Stereotactic and functional neurosurgery 102 4 da2cd6b6-0146-48e0-9460-bea6e5731290 Article (Published version) Restricted Cuony_2024.pdf 625113 application/pdf 6c9cb0c38aa7e6782645a679296512f0371edd439036114e51ce224e3120db7e 57e5b10e-58a6-480b-acb0-0892aafcac73 Supplemental data Restricted Supplementary_material-Supplementar.docx 36734 application/vnd.openxmlformats-officedocument.wordprocessingml.document b965d0b17335af3c313d612cc3bc43bbdf5a90a72c0fa3df3a445af74258a07f 32967fce-2115-46ab-952d-da3389a64e86 Supplemental data Restricted Supplementary material-Supplementar1.docx 14887 application/vnd.openxmlformats-officedocument.wordprocessingml.document 5e93220564ad38761fd2ebbdaef72ae27e8d4bad451bfd81fa127f4e18c72971 2a88865c-e5aa-4e26-b997-63c726a4b309 Supplemental data Restricted Supplementary_video-Thalamic_hand_a.mp4 18654391 video/mp4 a801e81fcaccd255e00a3a4ca294acc8d63bb6715dc5f1e22416f72de501fad7 56424b43-8936-4026-89bf-4f504476acdb Article (Accepted version) Public Cuony_Fleury_post-MRgFUS_thalamic_h.pdf 17859359 application/pdf Restricted 2026-01-01 11707df97eecfbd2d993dfdfa3ffc709cb610e619a524dc271079e135e1fe560 openAccess Faculté de médecine / Section de médecine clinique / Département des neurosciences cliniques Faculté de médecine / Section de médecine clinique / Département de radiologie et informatique médicale

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Cuony, Johanna