Microelectrode Recording and Radiofrequency Thalamotomy following Focused Ultrasound Thalamotomy

Vloo, Philippe De; Milosevic, Luka; Gramer, Robert; Dallapiazza, Robert F.; Lee, Darrin J.; Fasano, Alfonso; Hutchison, William D.; Lozano, Andrés M.; Schwartz, Michael L.; Kalia, Suneil K.

doi:10.1159/000510109

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…Some factors influencing this type of recurrence, which can also be partially considered a "loss of efficacy, " involve demographic factors, primarily the underlying pathology, where tremor recurrence is more frequent in patients affected by Parkinson's disease (PD) or long-standing essential tremor (ET) before developing PD symptoms. In our cases with early recurrence, however, only two were affected by PD (1,2,5,6,(12)(13)(14).…”

Section: Discussionmentioning

confidence: 61%

Early re-emerging tremor after MRgFUS thalamotomy: case–control analysis of procedural and imaging features

Bruno,

Badini,

Innocenzi

et al. 2024

Front. Neurol.

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PurposeThis study aimed to identify possible prognostic factors determining early tremor relapse after Magnetic Resonance guided Focused Ultrasound Surgery (MRgFUS) thalamotomy in patients with essential tremor (ET) and Parkinson’s disease (PD).MethodsNine patients (six ET and three PD) who underwent Vim MRgFUS thalamotomy in a single institution and developed early re-emergent tremor were analyzed. A control group of patients matched pairwise for sex, pathology, age, disease duration, and skull density ratio (SDR) was selected to compare the technical-procedural data and MR imaging evidence. MR imaging findings compared between groups included lesion shape and volume in multiparametric sequences, as well as Fractiona Anisotropy (FA) and Apparent Diffusion Coefficient (ADC) values derived from Diffusion Tensor Imaging Diffusion Weighted Imaging (DTI) and Diffusion Weighted Imaging (DWI) sequences.ResultsWe did not find statistically significant differences in gender and age between the two groups. Technical and procedural parameters were also similar in both treatment groups. In MRI analysis, we found lesions of similar size but with greater caudal extension in the control group with stable outcomes compared to patients with tremor relapse.ConclusionIn our analysis of early recurrences after thalamotomy with focused ultrasound, there were neither technical and procedural differences nor prognostic factors related to lesion size or ablation temperatures. Greater caudal extension of the lesion in patients without recurrence might suggest the importance of spatial consolidation during treatment.

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Section: Discussionmentioning

confidence: 61%

Early re-emerging tremor after MRgFUS thalamotomy: case–control analysis of procedural and imaging features

Bruno,

Badini,

Innocenzi

et al. 2024

Front. Neurol.

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“…De Vloo et al used the opportunity to perform microelectrode recording in a patient who underwent unsuccessful MRgHiFUS treatment reaching only subtherapeutic temperatures. They found normal cell activity and argued, that this finding supports the expectation of not harming brain tissue below a threshold of 55°C ( 10 ). Dallapiazza et al compared the results of DBS, MRgHiFUS, GKRS and RFA in a systematic review and found evidence, that indeed the use different technologies in the same targets leads to comparable results ( 11 ).…”

Section: Consensus Statementmentioning

confidence: 85%

Consensus Statement on High-Intensity Focused Ultrasound for Functional Neurosurgery in Switzerland

et al. 2021

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Background: Magnetic resonance-guided high-intensity focused ultrasound (MRgHiFUS) has evolved into a viable ablative treatment option for functional neurosurgery. However, it is not clear yet, how this new technology should be integrated into current and established clinical practice and a consensus should be found about recommended indications, stereotactic targets, patient selection, and outcome measurements.Objective: To sum up and unify current knowledge and clinical experience of Swiss neurological and neurosurgical communities regarding MRgHiFUS interventions for brain disorders to be published as a national consensus paper.Methods: Eighteen experienced neurosurgeons and neurologists practicing in Switzerland in the field of movement disorders and one health physicist representing 15 departments of 12 Swiss clinical centers and 5 medical societies participated in the workshop and contributed to the consensus paper. All experts have experience with current treatment modalities or with MRgHiFUS. They were invited to participate in two workshops and consensus meetings and one online meeting. As part of workshop preparations, a thorough literature review was undertaken and distributed among participants together with a list of relevant discussion topics. Special emphasis was put on current experience and practice, and areas of controversy regarding clinical application of MRgHiFUS for functional neurosurgery.Results: The recommendations addressed lesioning for treatment of brain disorders in general, and with respect to MRgHiFUS indications, stereotactic targets, treatment alternatives, patient selection and management, standardization of reporting and follow-up, and initialization of a national registry for interventional therapies of movement disorders. Good clinical evidence is presently only available for unilateral thalamic lesioning in treating essential tremor or tremor-dominant Parkinson's disease and, to a minor extent, for unilateral subthalamotomy for Parkinson's disease motor features. However, the workgroup unequivocally recommends further exploration and adaptation of MRgHiFUS-based functional lesioning interventions and confirms the need for outcome-based evaluation of these approaches based on a unified registry. MRgHiFUS and DBS should be evaluated by experts familiar with both methods, as they are mutually complementing therapy options to be appreciated for their distinct advantages and potential.Conclusion: This multidisciplinary consensus paper is a representative current recommendation for safe implementation and standardized practice of MRgHiFUS treatments for functional neurosurgery in Switzerland.

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“…Instead, recent autopsy studies have reported that the thalamus lesion by MRgFUS was characterized by many foamy macrophages, immunoreactive for CD68 and less for IBA-1, but relatively preserved neurons compared to the adjacent thalamus [19]. In some recurrence cases after MRgFUS thalamotomy, re-ablation or DBS implantation in these patients can still improve their tremor performance again [20][21][22]. Despite all the above reasons, ignoring the of the disease pathophysiology and the biological features is just an illusion of excitement brought about by technological advance.…”

Section: Discussionmentioning

confidence: 99%

Fibrinogen is the key factor associated with tremor relieve and recurrence in the ET patients subjected with unilateral MRgFUS thalamotomy

Lin,

Lu,

Zhang

et al. 2024

Preprint

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Background There were variable differences and declines in efficacy of magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy, but whether the clinical status of these patients was involved was still unknown. Methods We retrospectively reviewed the tremor symptoms and clinical variables (at hospitalization) of 59 essential tremor (ET) patients subjected with MRgFUS thalamotomy. Patients were categorized by the short-term tremor relieve, tremor recurrence within 12 months and long-term maintenance outcome. Multivariate logistic regression was used to screen independent factors and construct the nomogram. Additional harmaline-induced ET model in male ICR mice were employed, we evaluated the possible anti-tremor effects of fibrinogen knock-out. Results MRgFUS thalamotomy resulted in significant tremor relieve, multivariate analysis suggested fibrinogen (OR = 0.182, 95% CI = 0.042-0.796,) and monocyte count (OR = 0, 95% CI = 0-0.001) were independently associated with better short-term tremor relieve (>75%) at 1-month postoperatively. A total of nine ET patients (15.254%) experienced significant tremor recurrence. Admission systolic blood pressure (OR = 1.013, 95% CI = 1.010-1.062), hypertension comorbidity (OR = 2.163, 95% CI = 1.412-53.565) and fibrinogen (OR = 1.620, 95% CI = 1.047-24.376) independently contributed to tremor recurrence. There were 15 ET patients (25.424%) sustained long-term and effective tremor control. Only admission systolic blood pressure was the independent prognostic factor (OR = 0.880, 95% CI = 0.785-0.987) for this favorable outcome. The nomograms were established for better tremor relieve and tremor recurrence and have excellent performance as the AUCs were 0.829 and 0.853 (bootstrap repetition = 1000). Finally, FGB knock-out significantly suppressed harmaline-induced tremor in vivo (P < 0.001). Conclusion Fibrinogen and hypertension are key factors associated with tremor relieve and recurrence in the ET patients subjected with MRgFUS thalamotomy.

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Microelectrode Recording and Radiofrequency Thalamotomy following Focused Ultrasound Thalamotomy

Cited by 5 publications

References 8 publications

Early re-emerging tremor after MRgFUS thalamotomy: case–control analysis of procedural and imaging features

Early re-emerging tremor after MRgFUS thalamotomy: case–control analysis of procedural and imaging features

Consensus Statement on High-Intensity Focused Ultrasound for Functional Neurosurgery in Switzerland

Fibrinogen is the key factor associated with tremor relieve and recurrence in the ET patients subjected with unilateral MRgFUS thalamotomy

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