Outcome after Stereotactic Thalamotomy for Parkinsonian, Essential, and Other Types of Tremor

Jankovic, Joseph; Cardoso, Francisco; Grossman, Robert G.; Hamilton, Winifred J.

doi:10.1097/00006123-199510000-00011

Cited by 80 publications

(121 citation statements)

References 14 publications

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“…Young et al 37 showed an 87.5% rate of clinical improvement and a 12.5% failure rate. Jankovic et al 17 reported a 58% temporary complication rate following stereotactic thalamotomy and a 23% permanent complication rate. Complications like hemiparesis, altered mental status, thalamic hemorrhage, and homonymous hemianopia have been reported.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Mohammed

Patra

Nanda

2018

Neurosurgical Focus

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OBJECTIVEMagnetic resonance–guided focused ultrasound (MRgFUS) is a novel technique that uses high-intensity focused ultrasound to achieve target ablation. Like a lens focusing the sun’s rays, the ultrasound waves are focused to generate heat. This therapy combines the noninvasiveness of Gamma Knife thalamotomy and the real-time ablation of deep brain stimulation with acceptable complication rates. The aim of this study was to analyze the overall outcomes and complications of MRgFUS in the treatment of essential tremor (ET).METHODSA meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was made by searching PubMed, Cochrane library database, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Patients with the diagnosis of ET who were treated with MRgFUS were included in the study. The change in the Clinical Rating Scale for Tremor (CRST) score after treatment was analyzed. The improvement in disability was assessed with the Quality of Life in Essential Tremor Questionnaire (QUEST) score. The pooled data were analyzed by the DerSimonian-Laird random-effects model. Tests for bias and heterogeneity were performed.RESULTSNine studies with 160 patients who had ET were included in the meta-analysis. The ventral intermediate nucleus was the target in 8 of the studies. The cerebellothalamic tract was targeted in 1 study. There was 1 randomized controlled trial, 6 studies were retrospective, and 2 were prospective. The mean number of sonications given in various studies ranged from 11 ± 3.2 to 22.5 ± 7.5 (mean ± SD). The maximum delivered energy ranged from 10,320 ± 4537 to 14,497 ± 6695 Joules. The mean of peak temperature reached ranged from 53°C ± 2.3°C to 62.0°C ± 2.5°C. On meta-analysis with the random-effects model, the pooled percentage improvements in the CRST Total, CRST Part A, CRST Part C, and QUEST scores were 62.2%, 62.4%, 69.1%, and 46.5%, respectively. Dizziness was the most common in-procedure complication, occurring in 43.4%, followed by nausea and vomiting in 26.85% (pooled percentage). At 3 months, ataxia was the most common complication, occurring in 32.8%, followed by paresthesias in 25.1% of the patients. At 12 months posttreatment, the ataxia had significantly recovered and paresthesias became the most common persisting complication, at 15.3%.CONCLUSIONSThe MRgFUS therapy for ET significantly improves the CRST scores and improves the quality of life in patients with ET, with an acceptable complication rate. Therapy with MRgFUS is a promising frontier in functional neurosurgery.

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Section: Discussionmentioning

confidence: 99%

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Mohammed

Patra

Nanda

2018

Neurosurgical Focus

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“…Two studies employed CT scanning for at least part of the study 16,18 and the same two employed microelectrode or semi-microelectrode recording for physiologic localization. These methods seem important for proper localization within the thalamus, but controlled observations on this point are not available.…”

Section: Thalamotomymentioning

confidence: 99%

“…Results of Class III studies of thalamotomy using current techniques 15,16,18 reported moderate to good effect on contralateral tremor in 79 to 85% of cases (total 97 patients) at mean follow-ups of 17 to 41 months. The duration of benefit is good, as demonstrated by a study that found a significant long-term (>3 years; mean, 11 years) reduction in contralateral resting tremor.…”

Section: Thalamotomymentioning

confidence: 99%

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Evaluation of surgery for Parkinson’s disease

Hallett¹,

Litvan²

1999

Neurology

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the Task Force on Surgery for Parkinson's Disease* PD is a common disorder affecting on average 100 per 100,000 population. Despite the large number of medications available for the treatment of early and moderately advanced PD, options specifically designed for the patient with advanced disease are limited. Surgery for PD dates from 1939-1940, when Bucy and Case 1 and Klemme 2 excised parts of the cerebral cortex to treat tremor and dystonia, but this type of surgery produced hemiparesis. Surgical basal ganglia lesions were introduced a few years later by Meyers, 3,4 who found that pallidotomy produced significant relief of tremor, rigidity, and dyskinesias, but with considerable mortality. Stereotaxic techniques to coagulate the globus pallidus in PD were introduced in the 1950s by Spiegel and Wycis, 5,6 and Cooper was an early advocate of pallidal surgery.7 Based on the anatomic connections between the pallidum and the thalamus, Hassler introduced the concept of surgery on the ventrolateral nucleus of the thalamus. 8,9Microelectrode recording allowed Narabayashi 10,11 to find that lesioning the ventral intermediate (Vim) nucleus of the thalamus was the most specific target to control the tremor in PD. Neurosurgery reached its peak in the 1960s, but declined after the introduction of levodopa.The recent resurgence of surgery was initiated by adrenal medullary transplantation. The premise of adrenal medullary transplants was that these cells, when transplanted into patients with advanced PD, would survive and function as a new source of dopamine. The theoretical advantages of adrenal tissue include that the tissue comes from the patient, eliminating the issue of immunologic rejection; dopamine is a normal intermediate compound made by the chromaffin cells; and chromaffin cells may have neuritic morphology when grown in culture. The disadvantages include the non-neuronal source and the rather modest survival rates of cells in laboratory transplantation studies. Isolated case reports of effective treatment of advanced PD with unilateral transplantation of adrenal medullary cells into the striatum in the 1980s led to several clinical trials testing the safety and efficacy of this procedure.Fetal mesencephalon transplantation was introduced subsequently and is based on several considerations. First, PD is associated with relatively selective degeneration of dopaminergic cells located in the substantia nigra, a portion of the mesencephalon. Second, replacement of dopaminergic activity by means of precursor drugs, receptor agonists, or inhibitors of dopamine catabolism improves the signs and symptoms of PD. Third, laboratory evidence in experimental animals has demonstrated that grafts of dopamine-containing neurons improve behavioral models of PD. Fourth, in these animal models, grafts reinnervate the striatum and form synaptic connections with host neurons. As a result, a small number of research teams have developed programs for human fetal mesencephalic cell grafts in PD patients. Several published reports exist,...

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“…Since then lesions have been moved posteriorly to the VIM for selective thalamotomy for tremor. [8,9,20,24] Landmarks around the AC-PC line were used to target the contralateral VIM nucleus. In addition, subjective, visual inspection of MR images and Schaltenbrand and Bailey atlas [22] (anatomical landmarks) were also used in the decision-making process for target placement to account for anatomical variation in individual patients.…”

Section: Target Selectionmentioning

confidence: 99%

Gamma knife radiosurgery for thalamotomy in Parkinsonian tremor: a five-year experience

Duma¹,

Jacques²,

Kopyov³

et al. 1997

FOC

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Certain patients, for example elderly, high-risk surgical patients, may be unfit for radiofrequency thalamotomy to treat Parkinsonian tremor. Some patients, when given the opportunity, may choose to avoid an invasive surgical procedure. The authors retrospectively reviewed their experience using gamma knife radiosurgery for thalamotomies in this patient subpopulation. Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make 38 lesions in 24 men and 10 women (median age 73 years, range 58-87 years) over a 5-year period. A median radiation dose of 130 Gy (range 100-165 Gy) was delivered to 38 nuclei (four patients underwent bilateral thalamotomy) using a single 4-mm collimator following classic anatomical landmarks. Twenty-nine lesions were made in the left nucleus ventralis intermedius thalamus for right-sided tremor. Patients were followed for a median of 28 months (range 6-58 months). Independent neurological evaluation of tremor based on the change in the Unified Parkinson's Disease Rating Scale tremor score was correlated with subjective patient evaluation. Comparison was made between a subgroup of patients in whom “low-dose” lesions were made (range 110-135 Gy, mean 120 Gy) and those in whom “high-dose” lesions were made (range 140-165 Gy, mean 160 Gy) for purposes of dose-response information. Four thalamotomies (10.5%) failed, four (10.5%) produced mild improvement, 11 (29%) produced good improvement, and 10 (26%) produced excellent relief of tremor. In nine thalamotomies (24%) the tremor was eliminated completely. The median time to onset of improvement was 2 months (range 1 week-8 months) Concordance between an independent neurologist's evaluation and that of the patient was statistically significant (p < 0.001). Two patients who underwent unilateral thalamotomy experienced bilateral improvement of their tremor. There were no neurological complications. There was better tremor reduction in the high-dose group when compared with the low-dose group (p < 0.04). Although less effective than other stereotactic techniques, gamma knife radiosurgical thalamotomy offers tremor control with minimal risk to a patient population unsuited for open surgery.

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Outcome after Stereotactic Thalamotomy for Parkinsonian, Essential, and Other Types of Tremor

Cited by 80 publications

References 14 publications

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Evaluation of surgery for Parkinson’s disease

Gamma knife radiosurgery for thalamotomy in Parkinsonian tremor: a five-year experience

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