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Letter
Pain related to MRgFUS: a merely minor transient adverse event?
  1. Paolo Amami1,
  2. Sara Prioni1,
  3. Marco Fusar Poli1,
  4. Riccardo Pascuzzo2,
  5. Elisa Bocchi1,
  6. Nico Golfrè Andreasi3,
  7. Grazia Devigili3,
  8. Roberto Cilia3,
  9. Sara Rinaldo3,
  10. Vincenzo Levi4,
  11. Francesco Ghielmetti5,
  12. Marina Grisoli2,
  13. Marco Gemma6,
  14. Francesco DiMeco7,8,
  15. Roberto Eleopra3,
  16. Sylvie Piacentini1
  1. 1Clinical Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
  2. 2Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
  3. 3Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
  4. 4Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
  5. 5Medical Physics Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
  6. 6Intensive Care and Neuroanesthesia Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
  7. 7Department of Neurological Surgery, Fondazione IRCCS Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
  8. 8Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milano, Italy
  1. Correspondence to Sylvie Piacentini, Clinical Neuropsychology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy; sylvie.piacentini{at}istituto-besta.it

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Introduction

MR-guided focused ultrasound (MRgFUS) of the ventral intermediate (VIM) nucleus of the thalamus has recently emerged as a novel treatment option for medically refractory tremor in essential tremor and tremor-dominant Parkinson’s disease. The patient’s collaboration is crucial during MRgFUS, as intraoperative testing phases are performed during which tremor severity and any eventual side effects are assessed in order to select the optimal target before permanent lesioning. Head pain is among the most frequent transient adverse event associated with sonication,1 2 and in some cases, it may become so intense to hamper the patient’s cooperation and interfere with MRgFUS.3–5

This study aimed to evaluate the intensity of head pain associated with sonication. In particular, we were interested in identifying predictive factors of high-intensity head pain as it could be a source of interference with the procedure. Furthermore, we explored eventual dissociative or post-traumatic consequences related to high-intensity pain during MRgFUS.

Materials and methods

Consecutive patients treated with unilateral MRgFUS of the VIM were enrolled. Head pain associated with sonication and pain associated with frame placement was assessed separately using a Verbal Rating Scale. The Peritraumatic Dissociative Experiences Questionnaire (see supplementary references in online supplemental file 1 6 and the Impact of Event Scale-Revised (IES-R)7 were used to assess perioperative dissociative symptoms and acute stress symptoms, respectively. Demographic, clinical and MRgFUS-related data were also collected. Patients were split into two groups according to the rating of head pain intensity during sonication: the high pain (HP) group and the low-medium pain (LMP) group. Between-group comparisons and logistic regression analysis were performed. Details on materials and methods are reported in online supplemental material S1.

Supplemental material

[jnnp-2024-333401supp001.pdf]

Results

Among 95 patients treated with monolateral MRgFUS of the VIM, 85 patients were considered for the data analysis (details on selection, demographic, clinical and MRgFUS-related features are reported in …

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Footnotes

  • Contributors PA: research project: conception, organisation; statistical analysis: design, execution; manuscript preparation: writing of the first draft, review and critique; SP, MFP and EB: research project: execution; statistical analysis: review and critique; manuscript preparation: review and critique; RP: research project: conception; statistical analysis: design, execution, review and critique; manuscript preparation: review and critique; NGA, GD, VL and MGemma: research project: execution; statistical analysis: review and critique; manuscript preparation: review and critique; SR: research project: organisation; manuscript preparation: review and critique. RC, FG, MGrisoli and FD: research project: conception; statistical analysis: review and critique; manuscript preparation: review and critique; RE: research project: conception and execution; statistical analysis: review and critique; manuscript preparation: review and critique; SPiacentini: research project: conception, organisation; statistical analysis: review and critique; manuscript preparation: writing of the first draft, review and critique.

  • Funding The work was supported by the Italian Ministry of Health (Ricerca Corrente—RRC).

  • Competing interests RC has received speaking honoraria from Zambon, Zambon SAU, Bial Italia Srl and advisory board fees from Bial. PA, SP, MFP, RP, EB, NGA, GD, SR, VL, FG, MGemma, MGrisoli, FD, RE and SPiacentini reported no financial disclosure.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.