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MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
Published on: December 13, 2017
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Noninvasive Thalamotomy for Refractory Tremor by Frameless Radiosurgery
Mohamed H Khattab1, Anthony J Cmelak1, Alexander D Sherry1
1Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
International Journal of Radiation Oncology, Biology, Physics
|August 28, 2021
Summary
Frameless radiosurgical thalamotomy shows promise for treating essential and parkinsonian tremor. This noninvasive approach improved tremor symptoms and quality of life in a pilot study with good short-term safety.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Refractory essential tremor and Parkinson's disease tremor significantly impact quality of life.
- Traditional treatments like frame-based radiosurgery have limitations.
- There is a need for accessible, noninvasive treatment options.
Purpose of the Study:
- To evaluate the efficacy and safety of a noninvasive, frameless radiosurgical thalamotomy for essential and parkinsonian tremor.
- To compare outcomes with existing frame-based radiosurgery data.
- To assess improvements in tremor severity and quality of life.
Main Methods:
- A single-arm, prospective observational pilot trial was conducted.
- 33 adult patients with essential or Parkinson's disease tremor were enrolled.
- Frameless unilateral radiosurgical ablation of the ventral intermediate nucleus was performed, with outcomes assessed using the Fahn-Tolosa-Marin (FTM) scale and Quality of Life questionnaires at 1-year follow-up.
Main Results:
- An 83% treatment response rate was observed at 6 months based on FTM scores.
- Significant tremor reduction was noted, with a 41% average FTM score decrease at 6 months (P=.001).
- Quality of life improved by 57% in essential tremor patients; 6% experienced grade 2 adverse events at 1 year.
Conclusions:
- Noninvasive, frameless radiosurgical thalamotomy is a potentially feasible treatment for refractory tremor.
- The procedure demonstrates promising short-term efficacy and safety at 1-year follow-up.
- Further research with longer follow-up is necessary to confirm long-term safety and benefits.
