Task-Specific Focal Dystonia
Conditions
Brief summary
The purpose of this study is to assess the safety and effectiveness of MRI-guided focused ultrasound (MRgFUS) for treating task specific focal hand dystonias (TSFD). TSFD is a type of dystonia that affects hand movements during specific tasks such as writing, playing instruments or typing, often causing involuntarily movements or cramping.
Detailed description
The purpose of this study is to assess the safety and effectiveness of MRI-guided focused ultrasound (MRgFUS) for treating task specific focal hand dystonias (TSFD). TSFD refers to a condition where certain movements or tasks trigger involuntary muscle contractions, particularly during specialized and repetitive activities like writing (known as writer's dystonia), typing (typist's dystonia), playing musical instruments (musician's dystonia), or engaging in sports like golf, table tennis, or juggling. While TSFD affects around 1.2-1.5% of the general population, it's more common among athletes and musicians. Writer's dystonia, for example, typically starts with difficulty writing and hand cramping in the dominant hand, possibly spreading to the arm and shoulder muscles over time. In severe cases, the other hand may also be affected. Similarly, typist's dystonia can lead to finger flexion or extension issues during typing. Musician's dystonia is another form, seen in guitarists, pianists, harpists, or flute players, often emerging during the peak of their careers and significantly impacting musical performance. These dystonias can be career-ending as they impair performance and rarely go into remission, with onset often occurring around the age of forty. Surgical treatments for Task-Specific Focal Dystonia (TSFD) are less often explored than for other dystonias. Thalamotomy, targeting the ventro-oralis (Vo) nucleus, has shown some promise for hand dystonias like writer's cramp or musician's dystonia. Anecdotally, some benefit from deep brain stimulation (DBS) targeting the globus pallidus internus (GPi) has also been shown, but large-scale studies for TSFD are lacking. Another promising approach is MR guided focused ultrasound thalamotomy, a non-invasive procedure that uses real-time imaging to precisely target brain areas. This method has already shown success in treating essential tremors and Parkinson's disease symptoms. Recent studies and anecdotal cases have also demonstrated its potential for treating TSFD, with improvements in symptoms observed in patients with writer's cramp, musician's dystonia, and other related conditions. The Exablate MR Guided Focused Ultrasound Transcranial system is a device designed to overcome the limitations of delivering ultrasound through the intact skull. It uses advanced technology like water-cooling, acoustic correction algorithms, and patient-specific CT data to ensure precise and safe delivery of ultrasound energy to targeted brain areas. This pilot study protocol aims to utilize MR guided focused ultrasound thalamotomy as a treatment option for TSFD.
Interventions
The ExAblate Transcranial system will be used to destroy a small cluster of cells that may be causing the study participant's dystonia . The ExAblate uses ultrasound to heat a small spot in the brain called globus pallidus internus(GPi). Ultrasound passes through the skin and skull and into the brain to focus on this particular spot.
Sponsors
University of Maryland, Baltimore
Focused Ultrasound Foundation
InSightec
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DEVICE_FEASIBILITY
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Clinical diagnosis of moderate to severe TSFD with impact in their daily function or occupation function 2. Patients who failed to response or had unsatisfactory response to the first treatment, such as Botulinum toxin treatment or DBS or refuse these alternative options 3. Age greater than 21 and less than 75 years 4. Subjects who are able and willing to give consent and able to attend all study visits, 5. Documented chronic, symptoms for more than 6 months duration 6. Pallidotomy is feasible based on evaluation of imaging studies 7. Patient able to communicate sensations during the ExAblate TcMRgFUS treatment 8. Two members of the medical team have agreed upon inclusion and
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Treatment related adverse events | All events will be reported up to 6 months from treatment | Procedure related or device related adverse events will be reported, from the treatment day through the 6-month follow-up period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in dystonia intensity | 6 Months | Efficacy of ExAblate TcMRgFUS for pallidotomy will be evaluated using Arm disability dystonia scale (ADDS) and scales specific to writer's cramp (WCRS) or musician's dystonia (TMDS) scores. |
| Change in patient's perception of quality of life | 6 months | Quality of life assessments will be performed with short form (SF)-36 survey |
| Change in patient's perception of the effect of the procedure | 6 Months | Patient Global impression of change (PGIC): The effect of the procedure on patient perceived impact of pain related symptoms, emotions and quality of life will be measured using PGIC scale. |
Countries
United States
Contacts
CONTACTDheeraj Gandhi, MD
CONTACTNajme Hosseini
Outcome results
None listed