Related Papers
Clinical Neurology and Neurosurgery
Bilateral MRgFUS thalamotomy for tremor: A safe solution? Case report and review of current insights
2020 •
Alessia Catalucci
Brain
Focused ultrasound thalamotomy location determines clinical benefits in patients with essential tremor
2018 •
Jidan Zhong
Magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy is a novel and minimally invasive ablative treatment for essential tremor. The size and location of therapeutic lesions producing the optimal clinical benefits while minimizing adverse effects are not known. We examined these relationships in patients with essential tremor undergoing MRgFUS. We studied 66 patients with essential tremor who underwent MRgFUS between 2012 and 2017. We assessed the Clinical Rating Scale for Tremor (CRST) scores at 3 months after the procedure and tracked the adverse effects (sensory, motor, speech, gait, and dysmetria) 1 day (acute) and 3 months after the procedure. Clinical data associated with the postoperative Day 1 lesions were used to correlate the size and location of lesions with tremor benefit and acute adverse effects. Diffusion-weighted imaging was used to assess whether acute adverse effects were related to lesions encroaching on nearby major white matter tracts (medial lemnisc...
A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor
Beatriz Soto
Two year data from a preliminary study of double lesion site MRgFUS treatment of Essential Tremor targeting the thalamus and the posterior subthalamic area
2021 •
Olga Kirmi
Abstract: Background: MR-guided focused ultrasound (MRgFUS) is an effective treatment for essential tremor (ET). However, the optimal intracranial target sites remain to be determined. Objective: To assess MRgFUS induced sequential lesions in (anterior-VIM/VOP nuclei) the thalamus and then posterior subthalamic area (PSA) performed during the same procedure for alleviating ET. Methods: 14 patients had unilateral MRgFUS lesions placed in anterior-VIM/VOP then PSA. Bain-Findley Spirals were collected during MRgFUS from the treated arm (BFS-TA) and throughout the study from the treated (BFS-TA) and non-treated (BFS-NTA) arms and scored by blinded assessors. Although, the primary outcome was change in the BFS-TA from baseline to 12 months we have highlighted the 24 month data. Secondary outcomes included the Clinical Rating Scale for Tremor (CRST), Quality of Life for ET (QUEST) and PHQ-9 depression scores. Results: The mean improvement in the BFS-TA from baseline to 24 months was 41.1%...
Stereotactic and Functional Neurosurgery
Magnetic Resonance-Guided Focused Ultrasound Thalamotomy to Treat Essential Tremor in Nonagenarians
2020 •
Michael Schwartz
Essential tremor (ET) is a disabling movement disorder that is most prevalent among the elderly. While deep brain stimulation surgery targeting the ventral intermediate nucleus of the thalamus is commonly used to treat ET, the most elderly patients or those with multiple medical comorbidities may not qualify as surgical candidates. Magnetic resonance-guided focused ultrasound (MRgFUS) constitutes a less invasive modality that may be used to perform thalamotomy without the need for a burr hole craniotomy. Here, we report on 2 patients over the age of 90 years who benefited significantly from MRgFUS thalamotomy to relieve their symptoms and improve their quality of life. The procedure was well tolerated and performed safely in both patients. We conclude that age should not be a limiting factor in the treatment of patients with MRgFUS.
International Clinical Neuroscience Journal
Transcranial Focused Ultrasound in Functional Neurosurgery for Essential Tremor and Parkinson’s Disease: A Review Article
2016 •
Parisa Azimi
PURPOSE: Transcranial magnetic resonance guided focused ultrasound (MRgFUS) is a new development in the field of functional neurosurgery. A comprehensive review of the current literature was performed to evaluate of transcranial MRgFUS in treatment of essential tremor (ET) and Parkinson’s disease. METHODS: Articles available in electronic databases of PubMed, and Web of Science, as of July 2016 were reviewed. The strategy included a combination of key words 'MRgFUS', 'tremor', 'Parkinson', 'brain', ' head ', 'tumor', 'transcranial' and 'focused ultrasound' in the title and abstract of the manuscripts. In addition transcranial MRgFUS systems and cost-effectiveness of treatment were assessed. Finally, the major findings are summarized. RESULTS: Fifty-eight articles met the inclusion criteria for review. Among these, 15 studies eligible for inclusion in this review. The synthesis of the data demonstrated that, transcranial...
The Open …
Thalamotomy for Essential Tremor: A Very Long-Term Follow-Up
2012 •
Jan Van Doorn
Brain Communications
Improving tremor response to focused ultrasound thalamotomy
fabricio feltrin
MRI-guided high-intensity focused ultrasound thalamotomy is an incisionless therapy for essential tremor. To reduce adverse effects, the field has migrated to treating at 2 mm above the anterior commissure-posterior commissure plane. We perform MRI-guided high-intensity focused ultrasound with an advanced imaging targeting technique, four-tract tractography. Four-tract tractography uses diffusion tensor imaging to identify the critical white matter targets for tremor control, the decussating and non-decussating dentatorubrothalamic tracts, while the corticospinal tract and medial lemniscus are identified to be avoided. In some patients, four-tract tractography identified a risk of damaging the medial lemniscus or corticospinal tract if treated at 2 mm superior to the anterior commissure-posterior commissure plane. In these patients, we chose to target 1.2–1.5 mm superior to the anterior commissure-posterior commissure plane. In these patients, post-operative imaging revealed that th...
Ultrasound in Medicine and Biology
Neurophysiologic Correlates of Sonication Treatment in Patients with Essential Tremor
2015 •
Byoung-Kyong Min
Movement disorders : official journal of the Movement Disorder Society
Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor
2017 •
Vinod Ravikumar
Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance-guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost-effectiveness compared with existing procedural options. Literature searches of magnetic resonance-guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre- and postoperative tremor-related disability scores were collected from 32 studies involving 83 magnetic resonance-guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursem*nt was employed as a proxy for societal cost. Medicare reimbursem*nt rates are not established for magnetic resonance-guided focused ultrasound thalamotomy f...
