OBJECTIVE: The authors report their experience in treating patients suffering from medication-resistant essential tremor (ET) with MR-guided focused ultrasound (MRgFUS) thalamotomy over a 5-year period. METHODS: Forty-four ET patients treated with unilateral MRgFUS ventral intermediate nucleus (VIM) thalamotomy were assessed using the Clinical Rating Scale for Tremor (CRST) score and the Quality of Life in Essential Tremor Questionnaire (QUEST) over a 5-year span. RESULTS: Tremor was significantly improved immediately following MRgFUS in all patients and ceased completely in 24 patients. CRST scores in the treated hand at baseline (median 19; range 7-32, 44 patients) improved by a median of 16 at 1 month (44 patients; p < 0.0001), 17 at 6 months (31 patients; p < 0.0001), 15 at 1 year (24 patients; p < 0.0001), 18 at 2 years (15 patients; p < 0.0001), 19 at 3 years, (10 patients; p < 0.0001), 21 at 4 years (6 patients; p < 0.01), and 23 at 5 years (2 patients, significance not tested). Return of tremor that impacted activities of daily living was reported in 5 patients (11%). QUEST scores showed significant improvement, with median change of 35 points (p < 0.0001; 44 patients) at 1 month, 33 (p < 0.0001; 31 patients) at 6 months, 27 (p < 0.0001; 24 patients) at 1 year, 26 (p < 0.001; 15 patients) at 2 years, 25 (p < 0.001; 10 patients) at 3 years, 33 (p < 0.001; 6 patients) at 4 years, and 28 (significance not tested, 2 patients) at 5 years. Adverse events after the procedure were reversible in all but 5 patients (11%). CONCLUSIONS: MRgFUS thalamotomy for ET is an effective and safe procedure that provides long-term tremor relief and improvement in quality of life even in patients with medication-resistant disabling tremor. Additional studies with a larger group of patients is needed to substantiate these favorable results.
OBJECTIVE: The authors report their experience in treating patients suffering from medication-resistant essential tremor (ET) with MR-guided focused ultrasound (MRgFUS) thalamotomy over a 5-year period. METHODS: Forty-four ET patients treated with unilateral MRgFUS ventral intermediate nucleus (VIM) thalamotomy were assessed using the Clinical Rating Scale for Tremor (CRST) score and the Quality of Life in Essential Tremor Questionnaire (QUEST) over a 5-year span. RESULTS:Tremor was significantly improved immediately following MRgFUS in all patients and ceased completely in 24 patients. CRST scores in the treated hand at baseline (median 19; range 7-32, 44 patients) improved by a median of 16 at 1 month (44 patients; p < 0.0001), 17 at 6 months (31 patients; p < 0.0001), 15 at 1 year (24 patients; p < 0.0001), 18 at 2 years (15 patients; p < 0.0001), 19 at 3 years, (10 patients; p < 0.0001), 21 at 4 years (6 patients; p < 0.01), and 23 at 5 years (2 patients, significance not tested). Return of tremor that impacted activities of daily living was reported in 5 patients (11%). QUEST scores showed significant improvement, with median change of 35 points (p < 0.0001; 44 patients) at 1 month, 33 (p < 0.0001; 31 patients) at 6 months, 27 (p < 0.0001; 24 patients) at 1 year, 26 (p < 0.001; 15 patients) at 2 years, 25 (p < 0.001; 10 patients) at 3 years, 33 (p < 0.001; 6 patients) at 4 years, and 28 (significance not tested, 2 patients) at 5 years. Adverse events after the procedure were reversible in all but 5 patients (11%). CONCLUSIONS: MRgFUS thalamotomy for ET is an effective and safe procedure that provides long-term tremor relief and improvement in quality of life even in patients with medication-resistant disabling tremor. Additional studies with a larger group of patients is needed to substantiate these favorable results.
Entities:
Keywords:
CRST = Clinical Rating Scale for Tremor; ET = essential tremor; LOWESS = locally weighted scatterplot smoothing; MR-guided focused ultrasound; MRgFUS = MR-guided focused ultrasound; PD = Parkinson’s disease; QUEST = Quality of Life in Essential Tremor Questionnaire; SDR = skull density ratio; VIM = ventral intermediate nucleus; essential tremor; functional neurosurgery; surgery; thalamotomy; treatment
Authors: Jai Y Yu; Apoorva Rajagopal; Judy Syrkin-Nikolau; Sooyoon Shin; Kathryn H Rosenbluth; Dhira Khosla; Erika K Ross; Scott L Delp Journal: Front Neurosci Date: 2020-11-12 Impact factor: 4.677
Authors: Stuart H Isaacson; Elizabeth Peckham; Winona Tse; Olga Waln; Christopher Way; Melita T Petrossian; Nabila Dahodwala; Michael J Soileau; Mark Lew; Cameron Dietiker; Nijee Luthra; Pinky Agarwal; Rohit Dhall; John Morgan; Nicole Calakos; Theresa A Zesiewicz; Ejaz A Shamim; Rajeev Kumar; Peter LeWitt; Holly A Shill; Adam Simmons; Fernando L Pagan; Pravin Khemani; Jessica Tate; Brian Maddux; Lan Luo; William Ondo; Mark Hallett; Apoorva Rajagopal; Paula Chidester; Kathryn H Rosenbluth; Scott L Delp; Rajesh Pahwa Journal: Tremor Other Hyperkinet Mov (N Y) Date: 2020-08-14