書痙は、字を書こうとする時に手が振え、ミミズのような字になってしまったり、利き手をもう一方の手で支えなければ字が書けなくなってしまったりする疾患です。速記者、代書人、文筆家、教師など、字を書くことを仕事にしている人に発症者が多いと言われています(Wikipediaより改変引用)。
書痙に対しては、薬物など、さまざまな保存的治療が試みられていますが、著効を示す治療法は発見されていません。今回、われわれは、定位脳手術（視床凝固術）が著効した書痙の2例を報告するとともに、過去、国内外で定位脳手術が実施された31例の書痙例について検討させていただき、Stereotact Func Neurosurg誌に掲載されました。この研究は、当科の旭 雄士先生が多数の機能的手術の経験をもとにまとめてくれたものです。
Asahi T, Koh M, Kashiwazaki D, Kuroda S: Stereotactic neurosurgery for writer’s cramp. Report of two cases with an overview of the literature. Stereotact Func Neurosurg 92:405-411, 2014
http://www.ncbi.nlm.nih.gov/pubmed/25359570
A Voyage to Depth of Neuroscience Vol. 20 Stereotactic neurosurgery for writer’s cramp. Report of two cases with an overview of the literature.
Background: Writer’s cramp is a specific movement disorder with hand muscle cramps in writing, being classified into focal and action-specific dystonia. Stereotactic surgery, such as thalamotomy and deep brain stimulation (DBS), has been reported for writer’s cramp; however, the number of reported cases is still scarce and surgical procedures are also controversial. Objectives: In this study, therefore, we present 2 patients who underwent thalamotomy for writer’s cramp and systematically review the literature on stereotactic surgery for writer’s cramp. Methods: Case reports and literature review are presented. Results: Both patients underwent ventral oral nucleus (Vo) thalamotomy safely. Their symptoms completely disappeared after surgery and did not recur during follow-up periods. In the literature, a total of 31 cases were surgically treated for writer’s cramp. Stereotactic surgery included thalamotomy in 25 cases and DBS in 6. The target included the Vo in 17 cases, the ventral intermediate nucleus (Vim) in 3, and both Vo and Vim in 7. Both procedures markedly improved or resolved the symptoms. Transient neurological deficits were observed in 16.0% of patients after thalamotomy. Conclusions: The Vo may be the most effective target to treat writer’s cramp. Both thalamotomy and DBS are feasible and effective, but thalamotomy would be a better option, especially in younger or high-risk patients.
