MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes

Fasano, Alfonso; Llinas, Maheleth; Munhoz, Renato P.; Hlasny, Eugen; Kucharczyk, Walter; Lozano, Andrés M.

doi:10.1212/wnl.0000000000004268

Cited by 83 publications

(87 citation statements)

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“…MRI‐guided focused ultrasound (MRgFUS) is a novel, incision‐free invasive technique to ablate deep body targets, including brain . Open, single‐blind, and sham‐controlled double‐blind studies have confirmed the safety and efficacy of MRgFUS targeting ventro‐intermedius nucleus (Vim) in PD tremor. Tremor recurrence has been reported in up to a third of patients within the first 2 years, although others have reported a more sustained benefit, similar to that observed after radiofrequency thalamotomy …”

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confidence: 99%

“…He participated in our Vim‐MRgFUS for essential tremor (non‐ET) tremor trial (NCT02252380), targeting the dominant hemisphere (Fig. A) . At baseline, total, right‐hemibody and disability tremor rating scale (TRS) scores were 46, 26, and 12 (Supplementary Video Segment 1), respectively, and dropped by 80%, 96%, and 92% 1 week after the first Vim‐MRgFUS procedure (Supplementary Video Segment 2).…”

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Magnetic Resonance Imaging–Guided Focused Ultrasound Thalamotomy in Parkinson Tremor: Reoperation After Benefit Decay

et al. 2018

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Magnetic Resonance Imaging–Guided Focused Ultrasound Thalamotomy in Parkinson Tremor: Reoperation After Benefit Decay

et al. 2018

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“…Fasano and colleagues described a single‐blinded, single‐center, prospective study of 6 patients who underwent unilateral Vim MRgFUS for non‐ET tremor syndromes, 3 of whom were diagnosed with tremor‐dominant PD . All patients were followed to a maximum of 6 months, except for 1 with PD who expired from aspiration pneumonia 4 months postoperatively.…”

Section: Thalamotomymentioning

confidence: 99%

“…Fasano and colleagues described a single-blinded, singlecenter, prospective study of 6 patients who underwent unilateral Vim MRgFUS for non-ET tremor syndromes, 3 of whom were diagnosed with tremor-dominant PD. 36 All patients were followed to a maximum of 6 months, except for 1 with PD who expired from aspiration pneumonia 4 months postoperatively. Six months after the procedure, the remaining 5 patients exhibited a 52.9% decrease in single-blinded assessments of contralateral tremor using the Tremor Rating Scale (Parts A and B).…”

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The role of high‐intensity focused ultrasound as a symptomatic treatment for Parkinson's disease

et al. 2019

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MR‐guided focused ultrasound is a novel, minimally invasive surgical procedure for symptomatic treatment of PD. With this technology, the ventral intermediate nucleus, STN, and internal globus pallidus have been targeted for therapeutic cerebral ablation, while also minimizing the risk of hemorrhage and infection from more invasive neurosurgical procedures. In a double‐blinded, prospective, sham‐controlled randomized controlled trial of MR‐guided focused ultrasound thalamotomy for treatment of tremor‐dominant PD, 62% of treated patients demonstrated improvement in tremor scores from baseline to 3 months postoperatively, as compared to 22% in the sham group. There has been only one open‐label trial of MR‐guided focused ultrasound subthalamotomy for patients with PD, demonstrating improvements of 71% for rigidity, 36% for akinesia, and 77% for tremor 6 months after treatment. Among the two open‐label trials of MR‐guided focused ultrasound pallidotomy for patients with PD, dyskinesia and overall motor scores improved up to 52% and 45% at 6 months postoperatively. Although MR‐guided focused ultrasound thalamotomy is now approved by the U.S. Food and Drug Administration for treatment of parkinsonian tremor, additional high‐quality randomized controlled trials are warranted and are underway to determine the safety and efficacy of MR‐guided focused ultrasound subthalamotomy and pallidotomy for treatment of the cardinal features of PD. These studies will be paramount to aid clinicians to determine the ideal ablative target for individual patients. Additional work will be required to assess the durability of MR‐guided focused ultrasound lesions, ideal timing of MR‐guided focused ultrasound ablation in the course of PD, and the safety of performing bilateral lesions. © 2019 International Parkinson and Movement Disorder Society

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“…This emerging technology is used primarily for thermal ablation of central brain locations, such as for the treatment of essential tremor and Parkinson's disease. 5,21,41,50 MRg-FUS is an image-guided, noninvasive treatment option that can be used to manipulate the BBB and achieve focal CNS tumor drug delivery of systemically administered treatments. …”

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A review of potential applications of MR-guided focused ultrasound for targeting brain tumor therapy

Lamsam¹,

Johnson²,

Connolly³

et al. 2018

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Magnetic resonance–guided focused ultrasound (MRgFUS) has been used extensively to ablate brain tissue in movement disorders, such as essential tremor. At a lower energy, MRgFUS can disrupt the blood-brain barrier (BBB) to allow passage of drugs. This focal disruption of the BBB can target systemic medications to specific portions of the brain, such as for brain tumors. Current methods to bypass the BBB are invasive, as the BBB is relatively impermeable to systemically delivered antineoplastic agents. Multiple healthy and brain tumor animal models have suggested that MRgFUS disrupts the BBB and focally increases the concentration of systemically delivered antitumor chemotherapy, immunotherapy, and gene therapy. In animal tumor models, combining MRgFUS with systemic drug delivery increases median survival times and delays tumor progression. Liposomes, modified microbubbles, and magnetic nanoparticles, combined with MRgFUS, more effectively deliver chemotherapy to brain tumors. MRgFUS has great potential to enhance brain tumor drug delivery, while limiting treatment toxicity to the healthy brain.

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MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes

Abstract: This study provides Class IV evidence that for patients with tremor not caused by essential tremor, MRgFUS of the Vim improves the tremor of the contralateral hemibody at 6 months.

Cited by 83 publications

References 13 publications

Magnetic Resonance Imaging–Guided Focused Ultrasound Thalamotomy in Parkinson Tremor: Reoperation After Benefit Decay

Magnetic Resonance Imaging–Guided Focused Ultrasound Thalamotomy in Parkinson Tremor: Reoperation After Benefit Decay

The role of high‐intensity focused ultrasound as a symptomatic treatment for Parkinson's disease

A review of potential applications of MR-guided focused ultrasound for targeting brain tumor therapy

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