Neurosurgical treatment, especially deep brain stimulation (DBS) of globus pallidum interna (GPi), is known to play a very important role in management of dystonia. GPi DBS is generally used for treatment of generalized and segmental dystonias and its efficacy is well established. However, the role of neurosurgical treatment for focal dystonia, especially task-specific focal hand dystonia (TSFHD), is not widely known. Writer's cramp (WC) and occupational cramp like musician's cramp (MC) belong to this category. I have treated more than 100 patients with TSFHD with modern stereotactic thalamotomy of the nucleus ventro-oralis (Vo). The dystonic symptoms immediately improved after making a small thermo-controlled lesioning in the Vo nucleus of the thalamus. There were no permanent complications. Stereotactic Vo thalamotomy is effective and safe for of task-specific focal hand dystonia. 25 years have passed after introduction of modern DBS, and now I think it time to discuss pros and cons of DBS and lesioning humbly and seriously. Not only DBS but thalamotomy and other neurosurgical procedures play an important role in management of dystonias.
