Functional lesional neurosurgery for tremor: a systematic review and meta-analysis

Schreglmann, Sebastian R; Krauss, Joachim K.; Chang, Jin Woo; Bhatia, Kailash P.; Kägi, Georg

doi:10.1136/jnnp-2017-316302

Cited by 27 publications

(19 citation statements)

References 87 publications

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“…MRgFUS thalamotomy has emerged as an additional option for disabling ET. Because the first publication of favorable clinical results of MRgFUS thalamotomy in 2013, 5 a few additional reports have been provided regarding its results, 10,11 technical methods, 12 adverse effects, 13 and comparative outcomes with other therapeutic modalities 14 ; however, these studies have primarily been short term. 5,6,[9][10][11]15 With this treatment, the 12-month reduction rate of total CRST was 35% to 56%, hand tremor reduction rate was 40% to 78%, and disability reduction rate was 61% to 85% ( Table 2).…”

Section: Four-year Results Of Mrgfus Thalamotomymentioning

confidence: 99%

Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor

et al. 2019

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Background Following the emergence of magnetic resonance‐guided focused ultrasound as a promising tool for movement disorder surgery, thalamotomy for essential tremor using this technique has become a useful tool based on its efficacy and lack of adverse effects. Here, we summarize the 4‐year results of previous reports focusing on the durability of effectiveness of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor. Methods From October 2013 to August 2014, 15 patients with intractable essential tremor were enrolled. Twelve of them completed clinical assessment through 4 years of postoperative follow‐up. Tremor severity, task performance, and disability were measured using the Clinical Rating Scale of Tremor. Results The mean age of the 12 patients was 61.7 ± 8.1 years. Maximally delivered energy was 15,552.4 ± 6574.1 joules. The mean number of sonications was 17.3 ± 1.6. The mean postoperative lesion volume was 82.6 ± 29.023 mm3 and in 1 year was a mean of 9.667 ± 8.573 mm3. Four years postoperatively, improvement of the hand tremor score was 56%, that of the disability score was 63%, that of the postural score was 70%, and that of the action score was 63% compared with baseline; all improvements were significant and sustained over the 4‐year period after thalamotomy. There was no permanent adverse effect throughout the 4‐year follow‐up period. Conclusions Magnetic resonance‐guided focused ultrasound thalamotomy exhibits sustained clinical efficacy 4 years after the treatment of intractable essential tremor. Adverse events are generally transient. A large cohort of patients who have undergone magnetic resonance‐guided focused ultrasound thalamotomy with longer follow‐up is needed to confirm our findings. © 2019 International Parkinson and Movement Disorder Society

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Section: Four-year Results Of Mrgfus Thalamotomymentioning

confidence: 99%

Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor

et al. 2019

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“…7 Later in its evolution, when drug-related complications become unmanageable, effective treatment can still be achieved with surgical interventions, 8 that is, deep brain stimulation (DBS) 9 and focal ablation by radiofrequency or gamma knife. [10][11][12] However, all existing therapeutic options remain symptomatic, and no therapy is currently available to stop or slow the process underlying the onset and progression of the neurodegeneration. Despite promising preclinical results, all previous attempts in this direction have failed.…”

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confidence: 99%

“…In the early stages of PD, motor features can be treated effectively with dopaminergic drugs, particularly levodopa . Later in its evolution, when drug‐related complications become unmanageable, effective treatment can still be achieved with surgical interventions, that is, deep brain stimulation (DBS) and focal ablation by radiofrequency or gamma knife . However, all existing therapeutic options remain symptomatic, and no therapy is currently available to stop or slow the process underlying the onset and progression of the neurodegeneration.…”

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confidence: 99%

Focused ultrasound in Parkinson's disease: A twofold path toward disease modification

et al. 2019

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A major unmet need in Parkinson's disease (PD) is to slow the inexorable progression of neurodegeneration. Clinical trials that evaluated promising pharmacological strategies have repeatedly failed. Nonetheless, the advent of focused ultrasound provides new opportunities toward the goal of developing a safe and effective disease‐modifying therapy for PD. Here we discuss the rationale, possible avenues, and challenges along this path, exploiting the potential of focused ultrasound for (1) performing focal thermal lesions to restore the basic basal ganglia abnormalities associated with dopamine depletion, and (2) transiently opening the blood–brain barrier for targeted delivery of therapeutic agents. First, the classic idea of excitotoxicity mediated by hyperactivity of the subthalamic nucleus suggests that focused ultrasound subthalamotomy may offer a clinically viable disease‐modifying therapy in very‐early PD. Second, the concept of retrograde nigrostriatal neurodegeneration, supported by our recent cortical pathogenic theory of PD, points toward the putamen as a principal site for focused ultrasound blood–brain barrier opening and targeted drug delivery. In principle, both therapeutic strategies—subthalamotomy and putaminal blood–brain barrier opening—could eventually be applied in the same patient. Clinical application is still a long road ahead; nevertheless, focused ultrasound may open a twofold path toward disease modification in PD. © 2019 International Parkinson and Movement Disorder Society

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“…However, studies on long-term effects as well as a direct comparison with RF lesioning are lacking. Since a recent systematic review reported the highest overall rate of persistent side effects after MRgFUS, compared to Gamma Knife radiosurgery and RF [17], in our opinion RF thalamotomy is still the preferred option.…”

Section: Lesioning Techniquesmentioning

confidence: 86%

Long-Term Patient-Reported Outcome of Radiofrequency Thalamotomy for Tremor

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Oterdoom

Drost

et al. 2020

Stereotact Funct Neurosurg

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Background: Thalamotomy is an endorsed treatment for medication-refractory tremor. It used to be the standard, but nowadays deep brain stimulation (DBS) has become the treatment option of choice. Nevertheless, DBS has the disadvantage of hardware failure, battery replacement, and frequent setting adjustment. Radiofrequency (RF) thalamotomy lacks these issues, is relatively inexpensive, and has a broad applicability in patients with significant comorbidity. Therefore, we analyzed the long-term patient-reported outcome of RF thalamotomy in a cohort of patients with an otherwise intractable tremor. Methods: A single-center cohort of 27 consecutive patients with intractable tremor was assessed after unilateral RF thalamotomy. Over time, 4 patients had died because of non-related causes. In total, 21 patients responded to a telephone survey to assess their personal judgment on postoperative tremor severity, using a validated tremor scale, adverse events, recurrence, and patient satisfaction. The median time between surgery and telephone survey was 39 months (range 12-126). Seven patients had an additional analysis with postoperative imaging, video-assisted electromyography tremor registration, and a self-reported treatment effect (SRTE) assessment. Results: Nineteen out of 21 patients (90.5%) reported absence or significant improvement of their tremor. The rating score (WHIGET/ UPDRS-III) dropped significantly from a mean of 3.57 preoperatively to 1.05 postoperatively (p < 0.001). Eleven patients (52.4%) reported adverse events, but the majority (76.2%) did not consider the adverse events to be severe. SRTE assessment showed a direct postoperative effect of 89.6 of 100 points (SD 10.8), with a gradual decrease to 75.3 (SD 23.5) during follow-up. Conclusions: RF thalamotomy is a very effective long-term treatment for medication-refractory tremor and should therefore be considered in patients with a refractory unilateral tremor.

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Functional lesional neurosurgery for tremor: a systematic review and meta-analysis

Abstract: Background: This work evaluates the consistency, effect size and incidence of persistent side effects of lesional

Cited by 27 publications

References 87 publications

Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor

Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor

Focused ultrasound in Parkinson's disease: A twofold path toward disease modification

Long-Term Patient-Reported Outcome of Radiofrequency Thalamotomy for Tremor

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