MRgFUS Pallidotomy for the Treatment of Task Specific Focal Hand Dystonia (TSFD)

Eligibility Criteria

• 1. Clinical diagnosis of moderate to severe TSFD with impact in their daily function or occupation function
• 2. Patients who failed to response or had unsatisfactory response to the first treatment, such as Botulinum toxin treatment or DBS or refuse these alternative options
• 3. Age greater than 21 and less than 75 years
• 4. Subjects who are able and willing to give consent and able to attend all study visits,
• 5. Documented chronic, symptoms for more than 6 months duration
• 6. Pallidotomy is feasible based on evaluation of imaging studies
• 7. Patient able to communicate sensations during the ExAblate TcMRgFUS treatment
• 8. Two members of the medical team have agreed upon inclusion and exclusion criteria
• 1. Patient with contraindications to MRI such as severe claustrophobia and metallic implants incompatible with MRI.
• 2. Presence of generalized dystonia or involvement of two or more contiguous body regions (such as Arm along with neck)
• 3. Severe psychiatric disorder such as uncontrolled depression, anxiety, bipolar disorder, prior attempt at suicide or suicide ideation in preceding 12 months
• 4. Life expectancy less than 12 months
• 5. Anticoagulant or antiplatelet medications as well as underlying coagulopathy
• 6. Pregnant ladies or women of childbearing age who are sexually active and not using contraception
• 7. Inability to provide informed consent, for example due to underlying cognitive impairment or aphasia
• 8. Presence of intracranial mass or an acute intracranial abnormality
• 9. Subjects with unstable cardiac status such as unstable angina pectoris, documented myocardial infarction within 6 months of protocol entry or ejection fraction less than 40
• 10. Subjects exhibiting any behavior(s) consistent with ethanol or substance abuse as defined by the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders(DSM-IV)
• 11. Severe hypertension (diastolic blood pressure \> 100 on medication or persistently elevated systolic blood pressure\>140 mmHg despite adequate antihypertensive medications)
• 12. History of intracranial hemorrhage, traumatic brain injury or thalamic stroke.
• 13. Cerebrovascular disease (multiple cerebrovascular accident's (CVA) or CVA within 6 months)
• 14. Subjects with life-threatening systemic disease that include and not limited to the following will be excluded from the study participation: HIV, Liver Failure, blood dyscrasias, etc.
• 15. Subjects with a history of seizures within the past year
• 16. Individuals who are not able or willing to tolerate the required prolonged stationary supine position during treatment (can be up to 4 hours of total table time.)