Neurological adverse event profile of magnetic resonance imaging–guided focused ultrasound thalamotomy for essential tremor

Fishman, Paul S.; Elias, W. Jeffrey; Ghanouni, Pejman; Gwinn, Ryder P.; Lipsman, Nir; Schwartz, Michael L.; Chang, Jin Woo; Taira, Takaomi; Krishna, Vibhor; Rezai, Ali R.; Yamada, Kazumichi; Igase, Keiji; Cosgrove, Rees; Kashima, Haruhiko; Kaplitt, Michael G.; Tierney, Travis S.; Eisenberg, Howard M.

doi:10.1002/mds.27401

Cited by 82 publications

(52 citation statements)

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“…In patients treated with GKS, the response rate was 88% by Kondziolka et al, 82.3% near complete resolution by Frentress et al, 81.1% by Ohye et al, and 100% by Niranjan et al In a large series, Young et al reported 3.9% of permanent complications after GKS thalamotomy . As Fishman et al indicated, MRgFUS thalamotomy has not been performed without complications. When they performed a safety analysis of 186 patients treated with MRgFUS thalamotomy, procedure‐related serious adverse events were infrequent (1.6%), most adverse events were transient or mild (79%), and the rate of severe adverse events was 1% (most commonly balance and gait disturbances) .…”

Section: Discussionmentioning

confidence: 99%

“…As Fishman et al indicated, MRgFUS thalamotomy has not been performed without complications. When they performed a safety analysis of 186 patients treated with MRgFUS thalamotomy, procedure‐related serious adverse events were infrequent (1.6%), most adverse events were transient or mild (79%), and the rate of severe adverse events was 1% (most commonly balance and gait disturbances) . Thus, regarding the long‐term benefits for tremor control and the improvement of disability, MRgFUS thalamotomy seems to demonstrate benefits comparable to those of the DBS procedure (Tables and ).…”

Section: Discussionmentioning

confidence: 99%

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Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor

et al. 2019

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Background Following the emergence of magnetic resonance‐guided focused ultrasound as a promising tool for movement disorder surgery, thalamotomy for essential tremor using this technique has become a useful tool based on its efficacy and lack of adverse effects. Here, we summarize the 4‐year results of previous reports focusing on the durability of effectiveness of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor. Methods From October 2013 to August 2014, 15 patients with intractable essential tremor were enrolled. Twelve of them completed clinical assessment through 4 years of postoperative follow‐up. Tremor severity, task performance, and disability were measured using the Clinical Rating Scale of Tremor. Results The mean age of the 12 patients was 61.7 ± 8.1 years. Maximally delivered energy was 15,552.4 ± 6574.1 joules. The mean number of sonications was 17.3 ± 1.6. The mean postoperative lesion volume was 82.6 ± 29.023 mm3 and in 1 year was a mean of 9.667 ± 8.573 mm3. Four years postoperatively, improvement of the hand tremor score was 56%, that of the disability score was 63%, that of the postural score was 70%, and that of the action score was 63% compared with baseline; all improvements were significant and sustained over the 4‐year period after thalamotomy. There was no permanent adverse effect throughout the 4‐year follow‐up period. Conclusions Magnetic resonance‐guided focused ultrasound thalamotomy exhibits sustained clinical efficacy 4 years after the treatment of intractable essential tremor. Adverse events are generally transient. A large cohort of patients who have undergone magnetic resonance‐guided focused ultrasound thalamotomy with longer follow‐up is needed to confirm our findings. © 2019 International Parkinson and Movement Disorder Society

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor

et al. 2019

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“…Thus, our finding supports the idea that an over-impact of the DRTT could be related to the development of this side effect. Finally, paresthesias are also common after thalamotomy (Fishman et al, 2018), and are believed to be caused by the collateral impact in the sensory thalamus along the trajectory of the medial lemniscus (Kuncel, Cooper, & Grill, 2008;Shintani, Tsuruoka, & Shiigai, 2000). The four subjects in our series who developed sensory disturbances had a larger overlap FIGURE 4 Microstructural changes along the anatomical pathways in the nontarget hemisphere.…”

Section: Discussionmentioning

confidence: 99%

Microstructural changes of the dentato‐rubro‐thalamic tract after transcranial MR guided focused ultrasound ablation of the posteroventral VIM in essential tremor

Pineda‐Pardo

Martínez‐Fernández

Rodríguez‐Rojas

et al. 2019

Human Brain Mapping

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Essential tremor is the most common movement disorder in adults. In patients who are not responsive to medical treatment, functional neurosurgery and, more recently, transcranial MR‐guided focused ultrasound thalamotomy are considered effective therapeutic approaches. However, the structural brain changes following a thalamotomy that mediates the clinical improvement are still unclear. In here diffusion weighted images were acquired in a cohort of 24 essential tremor patients before and 3 months after unilateral transcranial MR‐guided focused ultrasound thalamotomy targeting at the posteroventral part of the VIM. Microstructural changes along the DRTT were quantified by means of probabilistic tractography, and later related to the clinical improvement of the patients at 3‐months and at 1‐year after the intervention. In addition the changes along two neighboring tracts, that is, the corticospinal tract and the medial lemniscus, were assessed, as well as the relation between these changes and the presence of side effects. Thalamic lesions produced local and distant alterations along the trajectory of the DRTT, and each correlated with clinical improvement. Regarding side effects, gait imbalance after thalamotomy was associated with greater impact on the DRTT, whereas the presence of paresthesias was significantly related to a higher overlap between the lesion and the medial lemniscus. This work represents the largest series describing the microstructural changes following transcranial MR‐guided focused ultrasound thalamotomy in essential tremor. These results suggest that clinical benefits are specific for the impact on the cerebello‐thalamo‐cortical pathway, thus reaffirming the potential of tractography to aid thalamotomy targeting.

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“…At least in principle, FUS ablation should be less prone to severe side effects such as intracerebral hemorrhage or infections compared with DBS. Even though accumulating data seem to indicate lower risks associated with FUS ablation, the number of treated patients is still too small to draw firm conclusions. It is important to stress that FUS treatments require a multidisciplinary team that is as complex as for DBS, and the methodology could be associated with reduced therapeutic efficacy in the hands of nonexperts or less experienced teams.…”

Section: The Subthalamic Nucleus As a Target To Halt Neurodegeneratiomentioning

confidence: 98%

Focused ultrasound in Parkinson's disease: A twofold path toward disease modification

et al. 2019

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A major unmet need in Parkinson's disease (PD) is to slow the inexorable progression of neurodegeneration. Clinical trials that evaluated promising pharmacological strategies have repeatedly failed. Nonetheless, the advent of focused ultrasound provides new opportunities toward the goal of developing a safe and effective disease‐modifying therapy for PD. Here we discuss the rationale, possible avenues, and challenges along this path, exploiting the potential of focused ultrasound for (1) performing focal thermal lesions to restore the basic basal ganglia abnormalities associated with dopamine depletion, and (2) transiently opening the blood–brain barrier for targeted delivery of therapeutic agents. First, the classic idea of excitotoxicity mediated by hyperactivity of the subthalamic nucleus suggests that focused ultrasound subthalamotomy may offer a clinically viable disease‐modifying therapy in very‐early PD. Second, the concept of retrograde nigrostriatal neurodegeneration, supported by our recent cortical pathogenic theory of PD, points toward the putamen as a principal site for focused ultrasound blood–brain barrier opening and targeted drug delivery. In principle, both therapeutic strategies—subthalamotomy and putaminal blood–brain barrier opening—could eventually be applied in the same patient. Clinical application is still a long road ahead; nevertheless, focused ultrasound may open a twofold path toward disease modification in PD. © 2019 International Parkinson and Movement Disorder Society

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Neurological adverse event profile of magnetic resonance imaging–guided focused ultrasound thalamotomy for essential tremor

Abstract: The overall safety profile of magnetic resonance imaging-guided focused ultrasound thalamotomy supports its role as a new option for patients with medically refractory essential tremor. © 2018 International Parkinson and Movement Disorder Society.

Cited by 82 publications

References 20 publications

Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor

Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor

Microstructural changes of the dentato‐rubro‐thalamic tract after transcranial MR guided focused ultrasound ablation of the posteroventral VIM in essential tremor

Focused ultrasound in Parkinson's disease: A twofold path toward disease modification

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