Grant: Project Grant

Dystonia, a disabling and painful condition, is the 3rd most common movement disorder (after tremor and Parkinson disease). Treatment options are limited to botox injections and medications. Many patients fail medical therapies leaving only deep brain stimulation (DBS) surgery. DBS surgery involves implanting a fine wire into specific brain regions and connecting this to an implantable pulse generator or brain pacemaker. It has revolutionized how we manage people with Parkinson disease and while it also improves some types of dystonia, its results applied to the usual target, the pallidum, are far more variable. We have minimal understanding of where and how dystonia arises. What we have learned over the past 20 years is that it involves multiple pathways in the brain, which have recently been discovered to be connected at one particular hub called the IL thalamus. Animal models of dystonia have implicated this deep brain target and disconnecting these 2 important circuits has improved dystonic movements. Yet in human dystonia we continue to target the pallidum, which is involved in only one of these pathways. Interestingly, we do surgery on the IL-thalamus in patients with other conditions, such as Tourette's syndrome or pain, confirming that it is safe to operate on in humans. This research project will examine the connections between the two critical pathways involved in dystonia in our patients and compare these to normal subjects both using large human databases and matched local subjects. This will provide the basis for a new surgical approach targeting the IL-thalamus, which has never been attempted for dystonia. Our overarching GOAL is to determine if IL-thalamus will provide a new target for dystonia treatment improving treatment options for this disabling condition.