Bilateral Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy for Essential Tremor

Fukutome, Kenji; Hirabayashi, Hidehiro; Osakada, Yosuke; Kuga, Yoshihiro; Ohnishi, Hideyuki

doi:10.1159/000518662

Cited by 26 publications

(26 citation statements)

References 39 publications

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“…Since publication of the landmark randomized controlled trial (RCT) demonstrating the safety and efficacy of MRgFUS thalamotomy in unilateral Essential Tremor (ET) (1), reports from several centers have documented sustained benefit from the procedure at long term follow-up (2)(3)(4)(5). Recent publications have attempted to identify key factors that may improve clinical outcomes following MRgFUS thalamotomy (4,(6)(7)(8)(9). Skull Density Ratio (SDR), lesion location and lesion volume have all been reported as important factors that determine tremor outcomes and the adverse event profile (7,10,11).…”

Section: Introductionmentioning

confidence: 99%

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Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures

et al. 2022

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IntroductionMRgFUS thalamotomy has gained popularity as an FDA approved, non-invasive treatment for patients with Essential Tremor and tremor predominant Parkinson's Disease. We present our initial clinical experience with 160 consecutive cases of MRgFUS thalamotomy and describe the clinical outcomes with long term follow-up.MethodsA retrospective chart review of all patients who underwent MRgFUS thalamotomy at our institution was performed. CRST Part A tremor scores were obtained pre-operatively and at each follow-up visit along with an assessment of side effects (SE). All patients had a post-operative MRI within 24 h to determine the location, size, and extent of the MRgFUS lesion.ResultsOne hundred and sixty unilateral MRgFUS Thalamotomies (Left, n = 128; Right, n = 32) were performed for medically refractory essential Tremor (n = 150) or tremor predominant Parkinson's disease (n = 10). Mean age at surgery was 75 Years (range: 48-93) and the mean skull density ratio (SDR) was 0.48 (range: 0.32-0.75; median: 0.46). In ET patients, both rest and postural tremor was abolished acutely and remained so at follow-up whereas intention tremor was reduced acutely by 93% below baseline, 87% at 3 months, 83.0% at 1-year, and 78% at 2 years. On post-operative day 1, the most common SE's included imbalance (57%), sensory disturbances (25%), and dysmetria (11%). All adverse events were rated as mild on the Clavien-Dindo Scale and improved over time. At 2-years follow-up, imbalance was seen in 18%, sensory disturbance in 10% and dysmetria in 8% patients. Mean clinical follow-up for all patients was 14 months (range: 1-48 months).ConclusionMRgFUS thalamotomy is a safe and effective procedure for long term improvement of unilateral tremor symptoms, with the most common side-effects being imbalance and sensory disturbance.

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Section: Introductionmentioning

confidence: 99%

“…SDR has also been reported as a key factor in achieving therapeutic temperature at target site (8). Despite several publications reporting outcomes following MRgFUS, the current literature is limited by small sample size, heterogeneity in institutional protocols and studies involving multiple surgeons (2)(3)(4)6).…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures

et al. 2022

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“…The recent publications by Martínez‐Fernández et al, 1 Iorio‐Morin et al, 2 and Fukutome et al 3 reported encouraging results after staged bilateral MRgHiFUS thalamotomy in essential tremor patients. These observations indicate that staged bilateral ablations with MRgHiFUS might be possible and safe.…”

Section: Discussionmentioning

confidence: 95%

Bilateral Focused Ultrasound Pallidotomy for Parkinson‐Related Facial Dyskinesia—A Case Report

Stieglitz

Mahendran

Oertel

et al. 2022

Movement Disord Clin Pract

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BackgroundBackground: For safety reasons, both magnetic resonance-guided high-intensity focused ultrasound (MRgHiFUS) thalamotomy and pallidotomy are currently approved exclusively for unilateral treatment, but axial symptoms like levodopa-induced orofacial dyskinesia require a bilateral approach. Objectives Objectives: We report the first case of successful bilateral MRgHiFUS pallidotomy for peak-dose dyskinesia in a patient with Parkinson's disease (PD). Methods Methods: The treatment decision was based on the patient's reluctance toward brain implants and pump therapies and the fact that he had limited access to a deep brain stimulation center in his home country. The treatment was planned as staged procedure with an interval of 18 months because of travel restrictions because of the coronavirus disease (COVID)-19 pandemic. ResultsResults: After the second treatment, levodopa-induced orofacial dyskinesia remitted and improved bradykinesia and rigidity with stable gait and good postural reflexes. Conclusions Conclusions: This promising result suggests that in selected PD patients with dyskinesia, staged bilateral MRgHiFUS pallidotomy might be considered.Magnetic resonance-guided high-intensity focused ultrasound (MRgHiFUS) is still a relatively new treatment option for movement disorders. The Food and Drug Administration (FDA) approved MRgHiFUS thalamotomy in July 2016 for the treatment of essential tremor, and in December 2018, an approval for treatment of tremor-dominant Parkinson's disease (PD) followed. Only very recently, in November 2021, the method gained an expansion of FDA approval to target the globus pallidus internus (GPi) to treat other PD symptoms including bradykinesia, rigidity, and dyskinesia. For safety reasons, both MRgHiFUS thalamotomy and pallidotomy are currently approved exclusively for unilateral treatment. We report the first case of a bilateral MRgHiFUS based pallidotomy for the treatment of disabling axial levodopa (L-dopa)-induced dyskinesia in a patient suffering from PD in the form of a named patient use. Methods Case DescriptionWe report the case of a 77-year-old Jordanian male patient. He was diagnosed with PD in 2018. After earlier onset of prodromal symptoms including hyposmia and rapid eye movement (REM) sleep behavior disorder, first motor symptoms including bradykinesia, and mild tremor started in 2016, together with mild depression and loss of weight because of reduced appetite. Immediately after diagnosis, treatment with L-dopa-carbidopa and amantadine was started, with satisfactory improvement of bradykinesia. However, in early 2020, disabling perioral peakdose dyskinesia occurred, leading to the introduction of amantadine that was later discontinued again because of loss of efficacy.

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“…However, majority of the available data for bilateral thalamotomy were published from the 1960s to 1980s when MRI and CT were not generally available to plan and confirm the ablative targets. Recent studies of bilateral thalamotomy indicated that dysarthria was mild or transient (19)(20)(21)(22)(23)(24). Nevertheless, the second thalamotomy should be carefully considered, and for a safe second thalamotomy, it is recommended to verify the absence of adverse events associated with the first thalamotomy, keep the longest possible interval between the first and second surgery (at least 12 moths), include patients aged less than 70 years, and ensure the smallest possible lesion volume.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Long-Term Suppression of Paroxysmal Kinesigenic Dyskinesia After Bilateral Thalamotomy

et al. 2021

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Background: Paroxysmal kinesigenic dyskinesia (PKD) is a movement disorder characterized by transient dyskinetic movements, including dystonia, chorea, or both, triggered by sudden voluntary movements. Carbamazepine and other antiepileptic drugs (AEDs) are widely used in the treatment of PKD, and they provide complete remission in 80–90% of medically treated patients. However, the adverse effects of AEDs include drowsiness and dizziness, which interfere with patients' daily lives. For those with poor compatibility with AEDs, other treatment approaches are warranted.Case Report: A 19-year-old man presented to our institute with right hand and foot dyskinesia. He had a significant family history of PKD; his uncle, grandfather, and grandfather's brother had PKD. The patient first experienced paroxysmal involuntary left hand and toe flexion with left forearm pronation triggered by sudden voluntary movements at the age of 14. Carbamazepine (100 mg/day) was prescribed, which led to a significant reduction in the frequency of attacks. However, carbamazepine induced drowsiness, which significantly interfered with his daily life, especially school life. He underwent right-sided ventro-oral (Vo) thalamotomy at the age of 15, which resulted in complete resolution of PKD attacks immediately after the surgery. Four months after the thalamotomy, he developed right elbow, hand, and toe flexion. He underwent left-sided Vo thalamotomy at the age of 19. Immediately after the surgery, the PKD attacks resolved completely. However, mild dysarthria developed, which spontaneously resolved within three months. Left-sided PKD attacks never developed six years after the right Vo thalamotomy, and right-sided PKD attacks never developed two years after the left Vo thalamotomy without medication.Conclusion: The present case showed long-term suppression of bilateral PKDs after bilateral thalamotomy, which led to drug-free conditions.

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Bilateral Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy for Essential Tremor

Cited by 26 publications

References 39 publications

Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures

Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures

Bilateral Focused Ultrasound Pallidotomy for Parkinson‐Related Facial Dyskinesia—A Case Report

Case Report: Long-Term Suppression of Paroxysmal Kinesigenic Dyskinesia After Bilateral Thalamotomy

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