Factors Associated with Headache and Nausea During Magnetic Resonance–Guided Focused Ultrasound for Tremor

Abstract

BackgroundBackground: During magnetic resonance-guided focused ultrasound for essential or parkinsonian tremor, adverse events (headache, nausea/vomiting, or anxiety) may alter the outcome of the procedure despite being mostly transient and mild. Objectives Objectives: Our aim was to analyze the relationship between demographic, procedural, and anesthetic characteristics with magnetic resonance/ultrasound-related events. Methods Methods: This was a retrospective study at the Clinica Universidad de Navarra of patients undergoing thalamotomy with magnetic resonance-guided focused ultrasound between September 2018 and October 2019. The anesthesia protocol included headache and nausea/vomiting prophylaxis and rescue therapy. Dexmedetomidine was used for anxiolysis in some patients after thorough multidisciplinary assessment. Results Results: A total of 123 patients were included. Headache was directly related to skull density ratio (P < 0.001) and skull thickness (P = 0.02). Patients with a skull density ratio less than 0.48 had 3 times the odds of experiencing moderate or severe headache (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.21-7.82) and had a higher odds of aborting sonication due to pain. Sex was associated with increased nausea (P = 0.007). Women had 4 times the odds of nausea than men (OR, 4.4; 95% CI, 1.61-12.11). Dexmedetomidine did not reduce headache or nausea incidence. Patients who received dexmedetomidine had a higher number (P = 0.01) and total minutes of sonication (P = 0.01). Conclusions Conclusions: Patients with lower skull density ratios and higher skull thicknesses could benefit from an aggressive analgesic prophylaxis. Women are more likely to experience nausea. Dexmedetomidine did not reduce headache and nausea, but increased the number and duration of sonications. Its exact effect on tremor is still unclear.

Magnetic resonance imaging‐guided focused ultrasound thalamotomy launch with remote telemedicine international proctorship

“…These symptoms were short-term and disappeared immediately after the patients were transferred to the ward. Gait instability that disappeared completely after 2 weeks was observed in five patients after the intervention, which is consistent with the data of Cacho-Asenjo et al 16 Regarding anamnesis, 27 (100%) patients received drug therapy, but due to side effects and insufficient effectiveness, 26 patients stopped taking these drugs even before applying MRgFUS treatment. Among the reasons for discontinuation of drug therapy, propranolol was canceled due to low efficacy at low doses, with an increase in dosage due to general weakness and a decrease in blood pressure and pulse rate; topiramate due to low efficiency with prolonged use, lethargy, and insomnia; primidone was not available in the country; and alprazolam caused drowsiness, lethargy, and addiction in one patient.…”

First use of MRI-guided focused ultrasound to treat patients with essential tremor in Russia

“…У 5 пациентов после операции отмечена неустойчивость походки, которая полностью прошла через 2 нед, что согласуется с данными Е. Cacho Asenjo и соавт. [21].…”

Characteristics of Pain During MRI-Guided Focused Ultrasound Thalamotomy

“…Head pain during sonication is common, and in some cases, the treatment has to be aborted because of severe pain. 22-24 Despite the administration of analgesics such as nonsteroidal anti-inflammatory drugs, acetaminophen, or at some institutes, dexamethasone, 22,25,26 pain is not always well controlled. The location and severity of the pain vary across patients, and it is difficult for physicians to imagine the type of pain provoked by high-energy ultrasound sonication.…”

“…drugs, acetaminophen, or at some institutes, dexamethasone, 22,25,26 pain is not always well controlled. The location and severity of the pain vary across patients, and it is difficult for physicians to imagine the type of pain provoked by high-energy ultrasound sonication.…”

“…1,2,6,9,[12][13][14][15][16][17][18][19][20][21] Head pain during sonication is common, and in some cases, the treatment has to be aborted because of severe pain. [22][23][24] Despite the administration of analgesics such as nonsteroidal anti-inflammatory ABBREVIATIONS: CRST, clinical rating scale for tremor; MRgFUS, magnetic resonance imaging-guided focused ultrasound; NRS, numerical rating scale; SDR, skull density ratio; SF-MPQ2, Short-Form McGill Pain Questionnaire 2; VIM, ventral intermediate. Supplemental digital content is available for this article at neurosurgery-online.…”