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Link to original content: http://pubmed.ncbi.nlm.nih.gov/32641664/
Two-year Follow-up Results of Magnetic Resonance Imaging-guided Focused Ultrasound Unilateral Thalamotomy for Medication-refractory Essential Tremor - PubMed Skip to main page content
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. 2020 Oct 15;59(20):2481-2483.
doi: 10.2169/internalmedicine.4360-19. Epub 2020 Jul 7.

Two-year Follow-up Results of Magnetic Resonance Imaging-guided Focused Ultrasound Unilateral Thalamotomy for Medication-refractory Essential Tremor

Hisashi Ito  1 , Kazuaki Yamamoto  2 , Shigeru Fukutake  1 , Takashi Odo  1 , Tetsumasa Kamei  1
Affiliations

Two-year Follow-up Results of Magnetic Resonance Imaging-guided Focused Ultrasound Unilateral Thalamotomy for Medication-refractory Essential Tremor

Hisashi Ito et al. Intern Med. .

Abstract

Objective To investigate the long-term efficacy and safety of magnetic resonance imaging-guided focused ultrasound (MRgFUS) unilateral ventral intermediate nucleus (Vim) thalamotomy for medication-refractory essential tremor (ET). Methods We performed MRgFUS left-sided Vim thalamotomy for 10 medication-refractory ET patients (8 men and 2 women, aged 67.1±17.5 years, all right-handed). We followed them for 2 years using the clinical rating scale for tremor (CRST) and the quality of life in essential tremor questionnaire (QUEST). Results Right-handed tremor improved immediately after the left Vim thalamotomy in all patients. The tremor became re-exacerbated in 2 patients by 6 months after treatment; however, an approximately 60% decrease in the average CRST score of the right hand persisted until 2 years. On the other hand, the average CRST score of the left hand and the average QUEST score showed no improvement. Headache was the most common adverse event during the sonication (8 patients), followed by a floating sensation (4 patients). On the other hand, sensory disturbances (4 patients) and gait instability (4 patients) were observed after the treatment, but most of them were mild and transient. There were no delayed adverse events. Conclusion MRgFUS unilateral Vim thalamotomy could be adopted as one of the therapeutic options for intractable ET. Further improvement of tremor in the targeted hand or contralateral Vim thalamotomy may be necessary to improve the quality of life.

Keywords: MRI-guided focused ultrasound; essential tremor; thalamotomy; ventral intermediate nucleus.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure.
Figure.
(A) Hand subscore of CRST of treated hand. (B) Hand subscore of CRST of non-treated hand. (C) GIS of QUEST. The improvement of the average CRST score of the right hand persisted until 2 years; however, both the average CRST score of the left hand and the average GIS of QUEST score showed no improvement (Dotted-lines are the average). CRST: clinical rating scale for tremor, GIS: global impression score, QUEST: quality of life in essential tremor questionnaire
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