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Subthalamotomy in cervical dystonia: A case study of lesion location and clinical outcome

Authors

  • Christian K.E. Moll MD,

    Corresponding author
    1. Department of Neurophysiology and Pathophysiology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
    • Department of Neurophysiology and Pathophysiology, Basal Ganglia Physiology Group, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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  • Wolfgang Hamel MD,

    1. Department of Neurosurgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
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  • Christoph B. Ostertag MD,

    1. Department of Stereotactic and Functional Neurosurgery, University-Hospital Freiburg, Freiburg, Germany
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  • Dieter Müller MD,

    1. Department of Neurosurgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
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  • Jürgen Finsterbusch PhD,

    1. Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
    2. Neuroimage Nord, University Medical Centers Hamburg-Kiel-Lübeck, Germany
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  • Andreas K. Engel MD, PhD,

    1. Department of Neurophysiology and Pathophysiology, Center of Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • Alexander Münchau MD

    1. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • Potential conflict of interest: None reported.

Abstract

Here we report a 63-year-old woman with primary cervical dystonia (CD) whose symptoms subsided for more than 30 years following a unilateral stereotactic subthalamotomy contralateral to the overactive left sternocleidomastoid muscle but then gradually recurred over a period of several months. The aim of the present study was to correlate the topography of the stereotactic lesion with the long lasting therapeutic effect. High-resolution magnetic resonance imaging and subsequent stereotactic analysis were performed to determine the anatomical localization of the lesion. The primary coagulation focus comprised the posterior subthalamic white matter in the prelemniscal radiation and field H of Forel. Neighboring structures were implicated to various extents. It is suggested that the posterior subthalamic area, with its abundance of interconnecting fibers and related nuclei, represents an effective target for the neurosurgical treatment of CD that may be explored further with deep brain stimulation. © 2008 Movement Disorder Society

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