Hand-foot dystonia can be congenital or secondary to various disorders of the brain. The lesions mainly involve the striatum, especially the shell nucleus and caudate nucleus. Common causes of hand-foot apraxia are 1 hereditary or familial, 2 cerebrovascular accidents, 3 intracranial infections, 4 drugs, 5 cerebral palsy, and 6 high cervical myelopathy.
There are three types depending on the clinical presentation:
(1) bilateral dystonia
(2) choreoathetoid dystonia
(3) unilateral and pseudothetoid dystonia
Currently, common medications are available:
1 levodopa, which is dramatically effective in dopa-responsive dystonia;2 anticholinergic agents, such as antan, may control the symptoms;3 diazepam or nitrazepam, which are effective in some cases;4 haloperidol, phenothiazines, or butemazine, which may be effective but may induce mild Parkinson's syndrome when effective doses are reached;5 baclofen and carbamazepine, which may also be effective.
There is also the possibility of stereotactic thalamic lateral nucleus destruction or thalamotomy in those with good intelligence and unilateral lesions.
We use a physical approach, minimally invasive surgical placement of a detachable pacemaker without side effects or sequelae, which can target the underlying lesions of the disease in the striatum, especially the nucleus accumbens and caudate nucleus, for the most effective treatment.