Journal article
Magnetic Resonance-Guided Focused Ultrasound for Treatment of Essential Tremor: Ventral Intermediate Nucleus Ablation Alone or Additional Posterior Subthalamic Area Lesioning?
Movement disorders clinical practice (Hoboken, N.J.), Vol.11(5), pp.504-514
05/2024
DOI: 10.1002/mdc3.14005
PMCID: PMC11078489
PMID: 38469997
Abstract
Background Magnetic resonance-guided focused ultrasound (MRgFUS) for treatment of essential tremor (ET) traditionally targets the ventral intermediate (Vim) nucleus. Recent strategies include a secondary lesion to the posterior subthalamic area (PSA). Objective The aim was to compare lesion characteristics, tremor improvement, and adverse events (AE) between patients in whom satisfactory tremor suppression was achieved with lesioning of the Vim alone and patients who required additional lesioning of the PSA. Methods Retrospective analysis of data collected from ET patients treated with MRgFUS at St Vincent's Hospital Sydney was performed. Clinical Rating Scale for Tremor (CRST), hand tremor score (HTS), and Quality of Life in Essential Tremor Questionnaire (QUEST) were collected pre- and posttreatment in addition to the prevalence of AEs. The lesion coordinates and overlap with the dentatorubrothalamic tract (DRTT) were evaluated using magnetic resonance imaging. Results Twenty-one patients were treated in Vim only, and 14 were treated with dual Vim-PSA lesions. Clinical data were available for 29 of the 35 patients (19 single target and 10 dual target). At follow-up (mean: 18.80 months) HTS, CRST, and QUEST in single-target patients improved by 57.97% (P < 0.001), 36.71% (P < 0.001), and 58.26% (P < 0.001), whereas dual-target patients improved by 68.34% (P < 0.001), 35.37% (P < 0.003), and 46.97% (P < 0.005), respectively. The Vim lesion of dual-target patients was further anterior relative to the posterior commissure (PC) (7.84 mm), compared with single-target patients (6.92 mm), with less DRTT involvement (14.85% vs. 23.21%). Dual-target patients exhibited a greater proportion of patients with acute motor AEs (100% vs. 58%); however, motor AE prevalence was similar in both groups at long-term follow-up (33% vs. 38%). Conclusion Posterior placement of lesions targeting the Vim may confer greater tremor suppression. The addition of a PSA lesion, in patients with inadequate tremor control despite Vim lesioning, had a trend toward better long-term tremor suppression; however, this approach was associated with greater prevalence of gait disturbance in the short term.
Details
- Title: Subtitle
- Magnetic Resonance-Guided Focused Ultrasound for Treatment of Essential Tremor: Ventral Intermediate Nucleus Ablation Alone or Additional Posterior Subthalamic Area Lesioning?
- Creators
- Kain Kyle - Cooperative Trials Group for Neuro-OncologyJames Peters - St Vincent's Hospital SydneyBenjamin Jonker - Royal Prince Alfred HospitalYael Barnett - St Vincent's Hospital SydneyJoel Maamary - UNSW SydneyMichael Barnett - Royal Prince Alfred HospitalJerome Maller - GE Healthcare (Netherlands)Chenyu Wang - Cooperative Trials Group for Neuro-OncologyStephen Tisch - UNSW Sydney
- Resource Type
- Journal article
- Publication Details
- Movement disorders clinical practice (Hoboken, N.J.), Vol.11(5), pp.504-514
- DOI
- 10.1002/mdc3.14005
- PMID
- 38469997
- PMCID
- PMC11078489
- NLM abbreviation
- Mov Disord Clin Pract
- ISSN
- 2330-1619
- eISSN
- 2330-1619
- Publisher
- Wiley
- Number of pages
- 11
- Grant note
- The Brain and Mind Centre Partnership Grant St Vincent's Hospital Sydney radiology department Council of Australian University Librarians
- Language
- English
- Date published
- 05/2024
- Academic Unit
- Radiology
- Record Identifier
- 9984848421002771
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