RT Journal Article
SR Electronic
T1 Bilateral staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of essential tremor: a case series study
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP jnnp-2020-325278
DO 10.1136/jnnp-2020-325278
A1 Raúl Martínez-Fernández
A1 Sujitha Mahendran
A1 Jose Angel Pineda-Pardo
A1 Lukas L Imbach
A1 Jorge U Máñez-Miró
A1 Fabian Büchele
A1 Marta del Álamo
A1 Rafael Rodriguez-Rojas
A1 Frida Hernández-Fernández
A1 Beat Werner
A1 Michele Matarazzo
A1 Ignacio Obeso
A1 Lain H Gonzalez-Quarante
A1 Günther Deuschl
A1 Lennart Stieglitz
A1 Christian R Baumann
A1 Jose A Obeso
YR 2021
UL http://jnnp.bmj.com/content/early/2021/04/26/jnnp-2020-325278.abstract
AB Background Unilateral magnetic resonance-guided focused ultrasound (FUS) thalamotomy is efficacious for the treatment of medically refractory essential tremor (ET). Viability of bilateral FUS ablation is unexplored.Methods Patients diagnosed with medically refractory ET and previously treated with unilateral FUS thalamotomy at least 5 months before underwent bilateral treatment. The timepoints were baseline (before first thalamotomy) and FUS1 and FUS2 (4 weeks before and 6 months after second thalamotomy, respectively). The primary endpoint was safety. Efficacy was assessed through the Clinical Rating Scale for Tremor (CRST), which includes subscales for tremor examination (part A), task performance (part B) and tremor-related disability (part C).Results Nine patients were treated. No permanent adverse events were registered. Six patients presented mild gait instability and one dysarthria, all resolving within the first few weeks. Three patients reported perioral hypoesthesia, resolving in one case. Total CRST score improved by 71% from baseline to FUS2 (from 52.3±12 to 15.5±9.4, p<0.001), conveying a 67% reduction in bilateral upper limb A+B (from 32.3±7.8 to 10.8±7.3, p=0.001). Part C decreased by 81% (from 16.4±3.6 to 3.1±2.9, p<0.001). Reduction in head and voice tremor was 66% (from 1.2±0.44 to 0.4±0.54, p=0.01) and 45% (from 1.8±1.1 to 1±0.8, p=0.02), respectively.Conclusion Bilateral staged FUS thalamotomy for ET is feasible and might be safe and effective. Voice and head tremor might also improve. A controlled study is warranted.