title: Improvement of Table Tennis Dystonia by Stereotactic Ventro-Oral Thalamotomy: A Case Report.
abstract: BACKGROUND
  Task-specific focal dystonia, such as writer's cramp and musician's cramp, is a type of dystonia that affects performance of particular tasks. Such movement disorders have been treated with stereotactic ventro-oral (Vo) thalamotomy with excellent outcomes. However, there has been no previous report of treatment of sport-related or athlete's dystonia by means of stereotactic surgery. We treated a patient with table tennis-related dystonia with Vo thalamotomy, and evaluated the outcome.
  
  
  METHODS
  A 20-year-old, female, left-handed table tennis player complained of difficulty hitting a ping-pong ball. She started playing table tennis at 8 years of age, practiced for more than 4 hours every day, and participated in national tournaments. Abnormal flexion of the left wrist when hitting a ball became apparent when she was 19 years old. The abnormal movement emerged on the forehand stroke and, subsequently, on the backhand, until finally she could not continue playing. The diagnosis was task-specific focal dystonia that did not recover with medication. She visited our hospital and underwent right Vo thalamotomy. The surgery was performed using local anesthesia, with the patient swinging a paddle during stimulation and coagulation of the thalamus. Her symptoms had improved completely the day after surgery, such that she was able to participate in tournaments again.
  
  
  CONCLUSIONS
  We applied Vo thalamotomy for the successful treatment of athlete's dystonia, suggesting that this condition has an underlying mechanism similar to that of other task-specific focal dystonias. This provides new hope to patients with athlete's dystonia refractive to other therapies.
authors.affiliation: Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Ishikawa, Japan. Electronic address: takashi-tym@umin.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Asahi
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Takaomi
authors.initials: T
authors.lastname: Taira
authors.affiliation: Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Ishikawa, Japan.
authors.forename: Kiyonobu
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Ishikawa, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Ishikawa, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Sato
mesh_terms: D056352:Athletes; D004421:Dystonia / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000379:methods*; D015865:Racquet Sports; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: Dystonia; Table tennis; Task-specific; Thalamotomy