Explained: What is focal dystonia? Is lesioning surgery better than DBS to treat this neurological condition?

Recently, a 53-year-old found himself suffering from focal hand dystonia – a neurological condition where involuntary muscle contractions occur in the hand, causing abnormal movements and it hinders fine motor skills. And so, it becomes challenging to carry out simple tasks such as writing or picking up things because suddenly fingers curl, hands clench, wrists twist and tasks that require fine motor skills are nearly impossible to execute, such as buttoning a shirt, sewing, etc.

Here comes the role of lesioning surgery, which brings hope to patients who face severe tremors and movement disorders. This surgery offers immediate and long-lasting relief thereby improving the quality of life.

But can this be an alternative to Deep Brain Stimulation (DBS)? Not really. Lesioning surgery and Deep Brain Stimulation (DBS) are two different neurosurgical procedures used to treat the same conditions – movement disorders, psychiatric disorders, etc. While lesioning surgery is a surgical procedure that involves creating a lesion in a specific area of the brain to disrupt abnormal brain activity, DBS is a surgical procedure that involves implanting an electrode in a specific area of the brain to deliver electrical impulses that modulate brain activity.

While a surgeon uses heat, cold, or radiation to destroy the targeted brain tissue during lesioning surgery, in DBS, the surgeon implants a neurostimulator similar to a pacemaker, under the skin, which delivers electrical impulses to the brain via an electrode. 

While lesioning surgery is typically irreversible, DBS is reversible, as the electrode can be removed or turned off. Experts believe that lesioning surgery can have permanent side-effects, while DBS side-effects are often reversible. 

Dr Pankaj Agarwal, Head of the Department of Neurology at Gleneagles Hospital in Parel Mumbai said, “Lesioning surgery is an excellent option for many patients with severe tremor and dystonia, either isolated or as part of diseases such as Parkinson’s disease or 'essential tremor' or other neurological diseases. Unlike DBS (deep brain stimulation), which requires the implantation of a pacemaker and is often expensive, lesioning surgery uses a heated metal tip (that uses radiofrequency waves) to silence abnormal circuits in certain nuclei or targets in the deep part of the brain.

By using precise radiofrequency waves to target abnormal brain circuits, this technique delivers immediate and lasting relief, significantly improving the patient’s quality of life. Many of our patients, who have been suffering for years, can now perform simple tasks like eating or writing without difficulty. The results are life-changing, and the procedure itself is highly specialized yet cost-effective.”

“This procedure is an excellent option for many movement disorders patients due to its immediate efficacy, affordability, and relative longevity. For patients who have struggled with chronic symptoms for many years, the results are almost miraculous and on-table, seen within minutes of the lesion being created. Moreover, the reduced cost and shorter recovery time make it an accessible option for many individuals who cannot afford DBS (deep brain stimulation), said, Dr Naren Nayak, Functional neurosurgeon, at Gleneagles Hospital.