Surgery
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The current surgical options for musicians' focal dystonia are deep-brain stimulation and more recently, focused ultrasound thalamotomy. Deep-brain stimulation requires brain surgery, whilst focused ultrasound involves the non-invasive controlled ablation of affected brain cells.
Deep brain stimulation
Deep brain stimulation involves implanting an electrical device similar to a pacemaker under the skin of the chest. Fine wires are then fed from the device to specific areas of the brain responsible for movement control when playing an instrument. Electronic signals are then generated by the device which then blocks the brain's ability to send dystonic signals to the affected muscles.
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After the device has been implanted, several sessions with the doctor are usually needed to fine-tune the electrical frequencies from the device. The device is battery-powered and needs to be replaced via a surgical procedure.
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There are several stories of musicians reducing their dystonic symptoms significantly by undergoing deep-brain stimulation. However, there are also plenty of stories that report no improvement or even a worsening of their dystonia.
It is important to understand the risks of this type of surgery. As well as the immediate surgical risks of brain surgery, including bleeding inside the brain, stroke, seizures, and infection, there are also other long-term drawbacks. There are no guarantees that the implanted electrical equipment will last more than 10 years or so, further surgical procedures are required to maintain the equipment, and the effectiveness of the surgery may reduce over time.
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Focused Ultrasound Thalamotomy
Very recently, focused ultrasound thalamotomies have begun to be carried out on people with focal hand dystonia. The procedure involves focused ultrasound beams being guided by an MRI machine to converge and ablate cells within a very specific part of the brain (the ventral-oral nucleus).
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Early indications have revealed significant improvements in dystonic symptoms among musicians. The risks associated with this procedure are significantly less than undertaking brain surgery and the outcomes appear to be more satisfactory.
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Focused ultrasound thalamotomy is a new procedure for focal hand dystonia, therefore at the present time, it remains difficult to find treatment centers that can offer this type of surgery.
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