Mohamed H Khattab1, Anthony J Cmelak2, Alexander D Sherry2, Guozhen Luo2, Li Wang3, Hong Yu4, Peter Hedera5, Fenna T Phibbs6, Christopher J Lindsell3, Joseph Neimat7, Austin N Kirschner2. 1. Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: mohamed.khattab@vumc.org. 2. Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee. 3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. 5. Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky. 6. Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee. 7. Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
Abstract
PURPOSE: We sought to determine whether a more widely accessible, noninvasive, frameless approach to radiosurgical thalamotomy would improve objective measures of refractory essential or parkinsonian tremor without added toxicity compared with reports of frame-based radiosurgery. METHODS AND MATERIALS: We conducted a single-arm pilot observational prospective trial of adult patients with essential or parkinsonian tremor from 2013 to 2019 and report results at 1-year follow-up. Patients were treated with frameless unilateral radiosurgical ablation of the thalamic ventral intermediate nucleus to a maximum dose of 160 Gy. Treatment response was measured by the Fahn-Tolosa-Marin (FTM) tremor rating scale and the Quality of Life in Essential Tremor or Parkinson's Disease Questionnaire obtained before treatment and at 3, 6, 9, and 12 months. RESULTS: Thirty-three patients, including 23 with essential tremor and 10 with Parkinson's disease, were enrolled. Overall treatment response rate per FTM was 83% (15 of 18) at 6 months. There was a marked improvement in tremor, with an average total FTM reduction of 21% at 3 months (from 46 to 30 points; P = .003) and 41% at 6 months (from 46 to 24 points; P = .001). At 6 months, functional decline had regressed by 54% (from 15 to 7 points; P = .001). Quality of life improved by 57% (P = .001) at 6 months in patients with essential tremor, and patients with Parkinson's disease had unchanged quality of life. At 1-year follow-up, grade 2 neurologic adverse events were observed in 6% (2 of 33) of patients without any grade ≥ 3 events. CONCLUSION: Noninvasive, frameless radiosurgical thalamotomy may be a feasible treatment for patients with refractory tremor and demonstrates short-term safety at 1-year follow-up. This pilot study provides promising preliminary descriptions of efficacy, and definitive estimates of long-term safety and benefit require further study with longer follow-up.
PURPOSE: We sought to determine whether a more widely accessible, noninvasive, frameless approach to radiosurgical thalamotomy would improve objective measures of refractory essential or parkinsonian tremor without added toxicity compared with reports of frame-based radiosurgery. METHODS AND MATERIALS: We conducted a single-arm pilot observational prospective trial of adult patients with essential or parkinsonian tremor from 2013 to 2019 and report results at 1-year follow-up. Patients were treated with frameless unilateral radiosurgical ablation of the thalamic ventral intermediate nucleus to a maximum dose of 160 Gy. Treatment response was measured by the Fahn-Tolosa-Marin (FTM) tremor rating scale and the Quality of Life in Essential Tremor or Parkinson's Disease Questionnaire obtained before treatment and at 3, 6, 9, and 12 months. RESULTS: Thirty-three patients, including 23 with essential tremor and 10 with Parkinson's disease, were enrolled. Overall treatment response rate per FTM was 83% (15 of 18) at 6 months. There was a marked improvement in tremor, with an average total FTM reduction of 21% at 3 months (from 46 to 30 points; P = .003) and 41% at 6 months (from 46 to 24 points; P = .001). At 6 months, functional decline had regressed by 54% (from 15 to 7 points; P = .001). Quality of life improved by 57% (P = .001) at 6 months in patients with essential tremor, and patients with Parkinson's disease had unchanged quality of life. At 1-year follow-up, grade 2 neurologic adverse events were observed in 6% (2 of 33) of patients without any grade ≥ 3 events. CONCLUSION: Noninvasive, frameless radiosurgical thalamotomy may be a feasible treatment for patients with refractory tremor and demonstrates short-term safety at 1-year follow-up. This pilot study provides promising preliminary descriptions of efficacy, and definitive estimates of long-term safety and benefit require further study with longer follow-up.
Authors: Sean P Devan; Guozhen Luo; Xiaoyu Jiang; Jingping Xie; Daniel Dean; Levi S Johnson; Manuel Morales-Paliza; Hannah Harmsen; Junzhong Xu; Austin N Kirschner Journal: Adv Radiat Oncol Date: 2022-07-19
Authors: In-Ho Jung; Kyung Won Chang; So Hee Park; Hyun Ho Jung; Jong Hee Chang; Jin Woo Chang; Won Seok Chang Journal: Sci Rep Date: 2022-08-11 Impact factor: 4.996