Pallidothalamic Tractotomy after Pallidotomy for Medication‐Refractory Dystonia: Preliminary Short‐Term Results from a Case Series of Five Patients

Background There is limited data regarding the role of pallidothalamic tract (PTT) lesioning after failure of pallidotomy. Objectives To report the role of unilateral PTT lesioning in refractory generalized dystonia following bilateral pallidotomy and hemi‐dystonia following unilateral pallidotomy. Methods A single‐center retrospective case series. Results Five patients underwent unilateral PTT lesioning after the failure of pallidotomy to control dystonia, including status dystonicus in one case. The interval between pallidotomy and PTT lesioning ranged from 2 to 90 months. Pre‐PTT surgery, BFMDRS‐M scores ranged from 20 to 87, and BFMDRS‐D scores ranged from 8 to 23. Immediately post‐PTT surgery, improvement was observed in four patients, with objective improvements ranging between 57.5 and 93.3% in the BFMDRS‐M score. Two patients developed adverse effects: one experienced a mild worsening of post‐pallidotomy dysarthria, and another developed impaired hand dexterity. Conclusions Our initial experience suggests that unilateral PTT lesioning holds promise as an option for lesional surgery following pallidotomy, in refractory dystonia.