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Related Experiment Video

Updated: Jul 4, 2025

MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
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Impact of biologically effective dose on tremor decrease after stereotactic radiosurgical thalamotomy for essential

Constantin Tuleasca1,2,3, Guillaume Carey4, Romain Barriol4

  • 1Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Rue du Bugnon 44-46, BH-08, CH-1011, Lausanne, Switzerland. constantin.tuleasca@gmail.com.

Neurosurgical Review
|January 31, 2024
PubMed
Summary

Biologically effective dose (BED) correlates with tremor reduction after stereotactic radiosurgery (SRS) for essential tremor (ET). Optimal BED for tremor improvement is 4300-4500 Gy2.47, with higher doses increasing adverse radiation events.

Keywords:
Biologically effective doseEssential tremorRadiosurgeryTETRAS

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Area of Science:

  • Neurosurgery
  • Radiation Oncology
  • Neurology

Background:

  • Stereotactic radiosurgery (SRS) offers an alternative surgical option for managing drug-resistant essential tremor (ET).
  • Thalamotomy via SRS is a recognized procedure for ET treatment.
  • Evaluating dose-response relationships is crucial for optimizing SRS efficacy and safety.

Purpose of the Study:

  • To determine if biologically effective dose (BEDGy2.47) is associated with tremor improvement following SRS thalamotomy.
  • To identify optimal BED ranges for tremor control and assess the risk of adverse radiation events (AREs).

Main Methods:

  • Retrospective analysis of 78 patients with essential tremor treated with SRS thalamotomy (130 Gy single fraction).
  • Assessment of tremor severity using the TETRAS scale at 12 months post-SRS.
  • Calculation of BEDGy2.47 and correlation with clinical outcomes and AREs.

Main Results:

  • A significant correlation was found between BEDGy2.47 and tremor improvement (TETRAS total and ADL scores).
  • Higher BED (>4600 Gy2.47) and longer beam-on times (>70 min) did not yield further clinical efficacy.
  • Adverse radiation events (AREs), including transient hemiparesis, occurred in 8.9% of patients, primarily at BED values >4500 Gy2.47.

Conclusions:

  • BEDGy2.47 is a relevant factor for tremor improvement after SRS thalamotomy in essential tremor.
  • An optimal BED range of 4300-4500 Gy2.47 appears to balance efficacy and safety.
  • Further validation in larger cohorts is recommended to confirm these findings.