Radiofrequenz-Läsionierung bei Hemidystonie: Systematische Übersichtsarbeit und Meta-Analyse bei individuellen Patientendaten

Radiofrequency lesioning (RL) has been a mainstay in functional neurosurgery to treat dystonic movement disorders, which was replaced by deep brain stimulation (DBS) in the late 1990s. Studies on RL have shown variable benefit in patients with hemidystonia. The aim of this systematic review is to summarize published reports on RL for hemidystonia and to evaluate clinical outcome.

A systematic literature review was performed according to PRISMA guidelines in PubMed, Embase, and Web of Science using a customized software (UiPath, NY) to identify all case reports, case series, and cohort studies reporting patients with hemidystonia treated with RF. Manuscripts were then automatically searched for the search term "hemidystonia". The selected manuscripts were manually screened to identify appropriate reports. Clinical improvement was classified as follows: (III) significant improvement; (II) moderate improvement; (I) mild improvement; (0) no improvement.

Twenty-eight reports totaling 101 cases published between 1962 and 2024 were included in our analysis in which individual patient data were available. Thalamotomy was performed in 80 cases, pallidotomy in 16 cases, and both in 5 cases. Overall, 18 patients (19.57%) had significant improvement at the last follow-up, while 41 (44.57%) patients had moderate improvement, 16 (17.39%) had mild improvement, and the remaining 18 patients (18.48%) had no clinical improvement. No significant difference was found between the outcome at immediate postoperative and last available follow-up. Similarly, there was no statistically significant difference between outcomes based on targets or based on etiology. However, trauma appeared to have a worse outcome. A significant negative linear correlation was found between percentage improvement and age at surgery. The lack of a standardized assessment of outcomes contributes to the difficulty in interpreting the result.

With recent advances in targeting methods, RL may be reconsidered as a treatment option for hemidystonia as an alternative to DBS. Further studies with standardized assessment of outcomes are needed to better characterize variability in outcome and to identify prognostic factors.