Sebastian R Schreglmann1, Ronald Bauer1, Stefan Hägele-Link1, Kailash P Bhatia1, Parashkev Natchev1, Nikolas Wegener1, Anita Lebeda1, Beat Werner1, Ernst Martin1, Georg Kägi2. 1. From the Departments of Neurology (S.R.S., S.H.-L., N.W., A.L., G.K.) and Neurosurgery (R.B.), Kantonsspital St. Gallen, Switzerland; Sobell Department of Motor Neuroscience and Movement Disorders (S.R.S., K.P.B.), University College London, Institute of Neurology, UK; Institute of Neurology (P.N.), Queen Square, London, UK; and Center for Focused Ultrasound (B.W., E.M.), University of Zurich, Children's Hospital Zurich, Switzerland. 2. From the Departments of Neurology (S.R.S., S.H.-L., N.W., A.L., G.K.) and Neurosurgery (R.B.), Kantonsspital St. Gallen, Switzerland; Sobell Department of Motor Neuroscience and Movement Disorders (S.R.S., K.P.B.), University College London, Institute of Neurology, UK; Institute of Neurology (P.N.), Queen Square, London, UK; and Center for Focused Ultrasound (B.W., E.M.), University of Zurich, Children's Hospital Zurich, Switzerland. georg.kaegi@kssg.ch.
Abstract
OBJECTIVE: To report results of a prospective trial of unilateral transcranial MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract in essential tremor (ET). METHODS: This was a prospective, uncontrolled, single-center interventional study. Patients with ET fulfilling criteria for interventional therapy received unilateral ablation of the cerebellothalamic tract (CTT) by MRIgFUS. Motor symptoms, manual dexterity, cognition, and quality of life were assessed before intervention and at 48 hours and 1, 3, and 6 months after intervention. Rating of standardized video recordings was blinded for evaluation time points. Primary outcome was the change in unilateral hand tremor score of the treated hand. RESULTS: Six patients received MRIgFUS ablation of the CTT contralateral to the treated hand. Repeated-measures comparison determined a statistically significant 83% reduction (before vs 6 months after intervention mean ± SD; absolute reduction; 95% confidence interval) in the unilateral treated hand subscore (14.3 ± 4.9 vs 2.5 ± 2.6; 11.8; 8.4-15.2; p < 0.001), while quality of life improved by 52% (50.5 ± 19.4 vs 24.8 ± 11.4; 25.7; 3.5-47.28; p = 0.046). Measures for manual dexterity, attention and coordination, and overall cognition were unchanged. Transient side effects (n = 3) were ipsilateral hand clumsiness and mild gait instability for up to 3 months. CONCLUSIONS: Unilateral MRIgFUS lesioning of the CTT was highly efficacious in reducing contralateral hand tremor in ET without affecting fine motor function and dexterity over 6 months of follow-up. Adverse effects were mild and transient. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with ET, transcranial MRIgFUS ablation of the cerebellothalamic tract improves tremor.
OBJECTIVE: To report results of a prospective trial of unilateral transcranial MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract in essential tremor (ET). METHODS: This was a prospective, uncontrolled, single-center interventional study. Patients with ET fulfilling criteria for interventional therapy received unilateral ablation of the cerebellothalamic tract (CTT) by MRIgFUS. Motor symptoms, manual dexterity, cognition, and quality of life were assessed before intervention and at 48 hours and 1, 3, and 6 months after intervention. Rating of standardized video recordings was blinded for evaluation time points. Primary outcome was the change in unilateral hand tremor score of the treated hand. RESULTS: Six patients received MRIgFUS ablation of the CTT contralateral to the treated hand. Repeated-measures comparison determined a statistically significant 83% reduction (before vs 6 months after intervention mean ± SD; absolute reduction; 95% confidence interval) in the unilateral treated hand subscore (14.3 ± 4.9 vs 2.5 ± 2.6; 11.8; 8.4-15.2; p < 0.001), while quality of life improved by 52% (50.5 ± 19.4 vs 24.8 ± 11.4; 25.7; 3.5-47.28; p = 0.046). Measures for manual dexterity, attention and coordination, and overall cognition were unchanged. Transient side effects (n = 3) were ipsilateral hand clumsiness and mild gait instability for up to 3 months. CONCLUSIONS: Unilateral MRIgFUS lesioning of the CTT was highly efficacious in reducing contralateral hand tremor in ET without affecting fine motor function and dexterity over 6 months of follow-up. Adverse effects were mild and transient. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with ET, transcranial MRIgFUS ablation of the cerebellothalamic tract improves tremor.
Authors: Jose A Pineda-Pardo; Raul Martínez-Fernández; Rafael Rodríguez-Rojas; Marta Del-Alamo; Frida Hernández; Guglielmo Foffani; Michele Dileone; Jorge U Máñez-Miró; Esther De Luis-Pastor; Lydia Vela; José A Obeso Journal: Hum Brain Mapp Date: 2019-03-13 Impact factor: 5.038
Authors: Qiyuan Tian; Max Wintermark; W Jeffrey Elias; Pejman Ghanouni; Casey H Halpern; Jaimie M Henderson; Diane S Huss; Maged Goubran; Christian Thaler; Raag Airan; Michael Zeineh; Kim Butts Pauly; Jennifer A McNab Journal: Neuroimage Clin Date: 2018-05-09 Impact factor: 4.881