Dystonia

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Focused Ultrasound Therapy

Focused ultrasound is a noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with dystonia. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue.

How it Works
Where the beams converge, focused ultrasound produces precise ablation (thermal destruction of tissue) enabling dystonia to be treated without surgery. While there are several potential treatment targets, the ventrooralis (Vo nucleus of the thalamus) has been the target of initial studies treating musician’s or writer’s dystonia.

Advantages
The primary options for treatment of dystonia include medications and invasive surgery. However, medications work temporarily, whereas focused ultrasound will offer a more durable treatment that may be permanent.

For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing or infection – at a lower cost. If needed, focused ultrasound can also be repeated.

Clinical Trials

A clinical trial for hand dystonia (also known as musicians or writer’s cramp) is being organized in the US for planned launch in 2023. More information will be announced as it is available.

clinical trial in Japan has begun treating patients with cervical dystonia has been completed.

A clinical trial in Toronto is treating patients with dystonia.  

Regulatory Approval and Reimbursement

Focused ultrasound treatment for dystonia is not yet approved by regulatory bodies or covered by medical insurance companies.

Notable Papers

Levi V, Stanziano M, Pinto C, Zibordi F, Fedeli D, Caldiera V, Cilia R, Golfrè Andreasi N, Braccia A, Carozzi C, Ciceri E, Grisoli M, Gemma M, Nazzi V, DiMeco F, Eleopra R, Zorzi G. Bilateral Simultaneous Magnetic Resonance-Guided Focused Ultrasound Pallidotomy for Life-Threatening Status Dystonicus. Mov Disord. 2024 Apr 19. doi: 10.1002/mds.29811. PMID: 38641910 

Golfrè Andreasi N, Braccia A, Levi V, Rinaldo S, Ghielmetti F, Cilia R, Romito LM, Bonvegna S, Elia AE, Devigili G, Telese R, Colucci F, Bruzzone MG, Messina G, Corradi M, Stanziano M, Caldiera V, Prioni S, Amami P, Fusar Poli M, Piacentini SHMJ, Grisoli M, Ciceri EFM, DiMeco F, Eleopra R. The Optimal Targeting for Focused Ultrasound Thalamotomy Differs between Dystonic and Essential Tremor: A 12-Month Prospective Pilot Study. Mov Disord Clin Pract. 2024 Jan;11(1):69-75. doi: 10.1002/mdc3.13911. Epub 2023 Nov 10. PMID: 38291839 

Alonto AHD, Jamora RDG. A scoping review on the diagnosis and treatment of X-linked dystonia-parkinsonism. Parkinsonism Relat Disord. 2024 Feb;119:105949. doi: 10.1016/j.parkreldis.2023.105949. Epub 2023 Nov 30. PMID: 38072720 

Larner P, Jonas R, Gutierrez CN, McGarey P, Lott J, Moosa S, Elias WJ, Daniero J. Voice Improvement After Essential Tremor Treatment via Focused Ultrasound and Deep Brain Stimulation. Laryngoscope. 2023 Jul 17. doi: 10.1002/lary.30884. PMID: 37458326 

Horisawa S, Yamaguchi T, Abe K, Hori H, Fukui A, Iijima M, Sumi M, Hodotsuka K, Konishi Y, Kawamata T, Taira T. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Focal Hand Dystonia: A Pilot Study. Mov Disord. 2021 May 29. doi: 10.1002/mds.28613.

Gallay MN, Moser D, Magara AE, Haufler F, Jeanmonod D. Bilateral MR-Guided Focused Ultrasound Pallidothalamic Tractotomy for Parkinson’s Disease With 1-Year Follow-Up. Front Neurol. 2021 Feb 9;12:601153. doi: 10.3389/fneur.2021.601153. eCollection 2021.

Martino D, Rockel CP, Bruno V, Mazerolle EL, Jetha S, Pichardo S, Pike GB, Kiss ZHT. Dystonia following thalamic neurosurgery: A single centre experience with MR-guided focused ultrasound thalamotomy. Parkinsonism Relat Disord. 2020 Feb;71:1-3. doi: 10.1016/j.parkreldis.2019.11.019. Epub 2019 Nov 26.

Horisawa S, Fukui A, Tanaka Y, Wendong L, Yamahata H, Kawamata T, Taira T. Pallidothalamic Tractotomy (Forel’s Field H1-tomy) for Dystonia: preliminary Results. World Neurosurg. 2019 Sep;129:e851-e856. doi:10.1016/j.wneu.2019.06.055. Epub 2019 Jun 14.

Horisawa S, Oka M, Kohara K. Kawamata T, Taira T. Staged bilateral pallidotomy for dystonic camptocormia: case report. J Neurosurg. 2018 Oct 19;131(3):839-842. doi: 10.3171/2018.5.JNS1840.

Horisawa S, Yamaguchi T, Abe K, Hori H, Sumi M, Konishi Y, Taira T. A single case of MRI-guided focused ultrasound ventro-oral thalamotomy for musician’s dystonia. J Neurosurg. 2018 Sep 21:1-3. doi: 10.3171/2018.5.JNS173125.

Krishna V, Sammartino F, Rezai A. A Review of the Current Therapies, Challenges, and Future Directions of Transcranial Focused Ultrasound Technology: Advances in Diagnosis and Treatment. JAMA Neurol. 2018 Feb 1;75(2):246-254. doi: 10.1001/jamaneurol.2017.3129.

Krack P, Martinez-Fernandez R, Del Alamo M, Obeso JA. Current applications and limitations of surgical treatments for movement disorders. Mov Disord. 2017 Jan;32(1):36-52. doi: 10.1002/mds.26890. Review.

Horisawa S, Taira T, Goto S, Ochiai T, Nakajima T. Long-term improvement of musician’s dystonia after stereotactic ventro-oral thalamotomy. Ann Neurol 2013;74:648-654.

Taira T, Hori T. Stereotactic ventrooralis thalamotomy for task-specific focal hand dystonia (writer’s cramp). Stereotact Funct Neurosurg 2003;80:88–91.

Taira T, Harashima S, Hori T. Neurosurgical treatment for writer’s cramp. Acta Neurochir 2003;[Suppl]87:129-131.

Goto S, Tsuiki H, Soyama N, et al. Stereotactic selective Vo-complex thalamotomy in a patient with dystonic writer’s cramp. Neurology 1997;49:1173–1174.

Click here for additional references on PubMed.

Clinical Trials