-
J. Neurol. Neurosurg. Psychiatr. · Aug 2022
Ipsilateral and axial tremor response to focused ultrasound thalamotomy for essential tremor: clinical outcomes and probabilistic mapping.
- Kazuaki Yamamoto, Can Sarica, Gavin J B Elias, Alexandre Boutet, Jurgen Germann, Aaron Loh, Suresh E Joel, Luca Bigioni, Dave Gwun, Robert Gramer, Stanley Xiangyu Li, Ajmal Zemmar, Artur Vetkas, Musleh Algarni, Gabriel Devenyi, Mallar Chakravarty, Kullervo Hynynen, Nadia Scantlebury, Michael L Schwartz, Andres M Lozano, and Alfonso Fasano.
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada.
- J. Neurol. Neurosurg. Psychiatr. 2022 Aug 22.
BackgroundMR-guided focused ultrasound (MRgFUS) thalamotomy has been shown to be a safe and effective treatment for essential tremor (ET).ObjectiveTo investigate the effects of MRgFUS in patients with ET with an emphasis on ipsilateral-hand and axial tremor subscores.MethodsTremor scores and adverse effects of 100 patients treated between 2012 and 2018 were assessed at 1 week, 3, 12, and 24 months. A subgroup analysis of ipsilateral-hand tremor responders (defined as patients with ≥30% improvement at any time point) and non-responders was performed. Correlations and predictive factors for improvement were analysed. Weighted probabilistic maps of improvement were generated.ResultsSignificant improvement in axial, contralateral-hand and total tremor scores was observed at all study visits from baseline (p<0.0001). There was no significant improvement in ipsilateral subscores. A subset of patients (n=20) exhibited group-level ipsilateral-hand improvement that remained significant through all follow-ups (p<0.001). Multivariate regression analysis revealed that higher baseline scores predict better improvement in ipsilateral-hand and axial tremor. Probabilistic maps demonstrated that the lesion hotspot for axial improvement was situated more medially than that for contralateral improvement.ConclusionMRgFUS significantly improved axial, contralateral-hand and total tremor scores. In a subset of patients, a consistent group-level treatment effect was observed for ipsilateral-hand tremor. While ipsilateral improvement seemed to be less directly related to lesion location, a spatial relationship between lesion location and axial and contralateral improvement was observed that proved consistent with the somatotopic organisation of the ventral intermediate nucleus.Trial Registration NumbersNCT01932463, NCT01827904, and NCT02252380.© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Notes
Knowledge, pearl, summary or comment to share?You can also include formatting, links, images and footnotes in your notes
- Simple formatting can be added to notes, such as
*italics*
,_underline_
or**bold**
. - Superscript can be denoted by
<sup>text</sup>
and subscript<sub>text</sub>
. - Numbered or bulleted lists can be created using either numbered lines
1. 2. 3.
, hyphens-
or asterisks*
. - Links can be included with:
[my link to pubmed](http://pubmed.com)
- Images can be included with:
![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
- For footnotes use
[^1](This is a footnote.)
inline. - Or use an inline reference
[^1]
to refer to a longer footnote elseweher in the document[^1]: This is a long footnote.
.