Newer advances in lesional surgery for movement disorders

Abstract

An analysis of the existing literature on lesioning for movement disorders was undertaken to review lesion therapy and its advances. Advances in imaging technology and electrophysiological techniques used for localization of brain structures and its functions, such as microelectrode recordings and macrostimulation, have greatly improved the ability to accurately identify the target nuclei such as the ventrointermediate nucleus (Vim), globus pallidus interna (GPi) and subthalamic nucleus (STN). Many important changes are happening in the understanding of lesion making. Its application as a cheaper modality of treatment; being less cumbersome; having a wider geographical appeal; and more options to create a lesion, appeals to the clinician. The procedure is undergoing a revival.

Outcome and Complications of MR Guided Focused Ultrasound for Essential Tremor: A Systematic Review and Meta-Analysis

“…At 4 years of follow up in 12 patients, a 56% reduction in hand score and 63% reduction in the disability scores was seen (37). The maximum available follow up of 5 years in two patients revealed a total CRST score of 8.0 (6-10) and QUEST score of 11.0 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), as compared to a baseline score of 46.0 (16-74) and 41.5 respectively (41).…”

“…The higher risk of side effects eventually led clinicians to consider DBS as a choice for surgical treatment of ET (7)(8)(9). However, there are several drawbacks related to its use, such as implant related complications and the requirement of frequent hospital visits for programming (10,11). GKT was developed as a relatively less invasive thalamotomy method, but suffered from unpredictable lesion size limitation and time taken for the clinical benefit to become apparent (12).…”