Successful Treatment of Baseball-Related Dystonia (Yips) with Ventro-Oral Thalamotomy
Successful Treatment of Baseball-Related Dystonia (Yips) with Ventro-Oral Thalamotomy
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腹口丘脑切除术成功治疗棒球相关肌张力障碍 (Yips)
DOI：
10.1002/mdc3.13637
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发表时间：
2022
影响因子：
4
通讯作者：
Takaomi Taira
中科院分区：
文献类型：
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作者：
Shiro Horisawa 1;Kazuki Kushi 1;Takakazu Kawamata 1;Takaomi Taira
Yips是一种运动障碍，包括震颤，抽搐或痉挛，仅在执行运动相关任务时发生。1棒球易激综合症是一种公认的，非常严重的疾病，可以结束职业棒球运动员的职业生涯。最近的研究表明，yips的病理生理学可能涉及一种任务特异性肌张力障碍。2在此，我们报告了第一例与投掷棒球有关的肌张力障碍，成功地用丘脑切开术治疗，这导致了一名棒球运动员的完全康复。患者为一名18岁健康右利手男性，5岁开始打棒球，是儿童棒球队的投手。在大约10岁时，他在投掷棒球时注意到右手不适。在初中时，右手僵硬经常发生在投掷棒球时。随着时间的推移，近距离投掷失误的频率逐渐增加。他在上高中时放弃了运动生涯。他在18岁时被转诊到我们医院。他的投球失误总是指向下方，这是因为右手腕不自主的弯曲导致难以释放棒球（视频1，图1A，B）。这些症状在任何情况下都是典型的，这表明这些症状可能没有心理根源。我们诊断患者患有与投掷棒球相关的任务特异性肌张力障碍。口服药物，包括苯海索（6 mg）、氯硝西泮（4 mg）、巴氯芬（15 mg）和唑吡坦（10 mg）无效。患者接受了左腹口（Vo）丘脑切开术（图1C）。详细的手术过程在我们之前的报告中有介绍。3手术后1天，他的近距离投掷能力显著改善（视频2）。他在手术后两周恢复了常规训练。手术后6个月，他成为了团队的正式成员（外展）。手术后，他的外野防守、跑动或击球都没有恶化。术后1年投掷情况较术后1天明显改善（图1D、E、录像3）。yips的病因可分为焦虑和肌张力障碍。2关于棒球运动员肌张力障碍的报道很少。Nakane等人4报告了2例与棒球活动相关的肌张力障碍病例。肩关节不自主运动和肘关节屈曲是肌张力障碍的症状。1例患者在3个月内接受了5次肌肉传入阻滞。轻微的肌张力障碍仍然存在，病人在这项运动中的作用仅限于代打。另一名患者接受了肉毒杆菌毒素注射（BTX），并出现了不良的肌无力。两名患者都没有完全恢复他们作为棒球运动员的表现。3口服药物或BTX应被视为局灶性肌张力障碍的一线治疗。如果肌张力障碍没有改善，丘脑Vo核的凝固可以被认为是任务特异性肌张力障碍的最后手段。3迄今为止，大多数报道使用丘脑Vo核治疗局灶性手肌张力障碍。5我们认为，
Yips is a motor disturbance that includes tremor, jerk, or spasm, occurring only when performing sport-related tasks. 1 Baseball yips is a well-recognized, extremely serious condition that can end the careers of professional baseball players. Recent studies suggest that the pathophysiology of yips may involve a form of task-specific dystonia. 2 Herein we report the first case of dystonia related to throwing a baseball successfully treated with thalamotomy, which resulted in complete recovery by a baseball player. The patient was an 18-year-old healthy right-handed man. He started playing baseball at the age of 5 years and was a pitcher in the children’s baseball team. At the age of approximately 10years, he noticed discomfort in the right hand while throwing a baseball. While attending junior high school, stiffness of the right hand occurred frequently while throwing a baseball. With time, the frequency of throwing errors in close range gradually increased. He gave up on his sports career while attending high school. He was referred to our hospital at the age of 18 years. His throwing error was always directed downward because of the difficulty in releasing the baseball caused by involuntary flexion of the right wrist (Video 1, Fig. 1A, B). The symptoms were always stereotypical under all circumstances, suggesting that the symptoms may not have a psychological origin. We diagnosed the patient with task-specific dystonia associated with throwing a baseball. Oral medications, including trihexyphenidyl (6 mg), clonazepam (4 mg), baclofen (15 mg), and zolpidem (10 mg), were not effective. The patient underwent left ventro-oral (Vo) thalamotomy (Fig. 1C). Detailed surgical procedures are shown in our previous report. 3 His throwing dramatically improved at close range 1 day after surgery (Video 2). He returned to regular practice 2 weeks after surgery. At 6 months after surgery, he was a regular member of the team (outfielder). There was no deterioration in his outfield defense, running, or batting after surgery. His throwing condition 1 year postoperatively was much better than 1day after surgery (Fig. 1D, E, Video 3).The causes of yips can be classified into those occurring from anxiety and those from dystonia. 2 Reports on dystonia in baseball players are scarce. Nakane et al 4 reported 2 cases of dystonia associated with baseball activities. Involuntary shoulder movements and elbow flexion were symptoms of dystonia. One patient underwent 5 muscle afferent blocks during a 3-month period. Slight dystonia remained, and the patient’s role in the sport was limited to being a pinch hitter. The other patient received botulinum toxin injections (BTX) and experienced undesirable muscle weakness. Neither patient fully regained their performance as a baseball player. 3 Oral medications or BTX should be considered as the first-line treatment for focal dystonia. If dystonia is not improved, coagulation of the thalamic Vo nucleus may be considered as a last resort for task-specific dystonia. 3 The majority of reports to date have used Vo nucleus of the thalamus for focal hand dystonia. 5 We believe that this