Neuropsychological and quality of life outcome after thalamic stimulation for essential tremor

Tröster, Alexander I.; Fields, Julie A.; Pahwa, Rajesh; Wilkinson, Steven B.; Straits-Tröster, Kristy; Lyons, Kelly E.; Kieltyka, Jennifer; Koller, William C.

doi:10.1212/wnl.53.8.1774

Cited by 140 publications

(109 citation statements)

References 37 publications

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“…This reversibility is not possible in ablative procedures like thalamotomy and MRgFUS. 34 It should also be noted that although DBS is reversible and nonablative, it is still invasive-and complications like hemorrhage, seizures, suboptimal electrode placement, and infection can occur.…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Mohammed

Patra

Nanda

2018

Neurosurgical Focus

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OBJECTIVEMagnetic resonance–guided focused ultrasound (MRgFUS) is a novel technique that uses high-intensity focused ultrasound to achieve target ablation. Like a lens focusing the sun’s rays, the ultrasound waves are focused to generate heat. This therapy combines the noninvasiveness of Gamma Knife thalamotomy and the real-time ablation of deep brain stimulation with acceptable complication rates. The aim of this study was to analyze the overall outcomes and complications of MRgFUS in the treatment of essential tremor (ET).METHODSA meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was made by searching PubMed, Cochrane library database, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Patients with the diagnosis of ET who were treated with MRgFUS were included in the study. The change in the Clinical Rating Scale for Tremor (CRST) score after treatment was analyzed. The improvement in disability was assessed with the Quality of Life in Essential Tremor Questionnaire (QUEST) score. The pooled data were analyzed by the DerSimonian-Laird random-effects model. Tests for bias and heterogeneity were performed.RESULTSNine studies with 160 patients who had ET were included in the meta-analysis. The ventral intermediate nucleus was the target in 8 of the studies. The cerebellothalamic tract was targeted in 1 study. There was 1 randomized controlled trial, 6 studies were retrospective, and 2 were prospective. The mean number of sonications given in various studies ranged from 11 ± 3.2 to 22.5 ± 7.5 (mean ± SD). The maximum delivered energy ranged from 10,320 ± 4537 to 14,497 ± 6695 Joules. The mean of peak temperature reached ranged from 53°C ± 2.3°C to 62.0°C ± 2.5°C. On meta-analysis with the random-effects model, the pooled percentage improvements in the CRST Total, CRST Part A, CRST Part C, and QUEST scores were 62.2%, 62.4%, 69.1%, and 46.5%, respectively. Dizziness was the most common in-procedure complication, occurring in 43.4%, followed by nausea and vomiting in 26.85% (pooled percentage). At 3 months, ataxia was the most common complication, occurring in 32.8%, followed by paresthesias in 25.1% of the patients. At 12 months posttreatment, the ataxia had significantly recovered and paresthesias became the most common persisting complication, at 15.3%.CONCLUSIONSThe MRgFUS therapy for ET significantly improves the CRST scores and improves the quality of life in patients with ET, with an acceptable complication rate. Therapy with MRgFUS is a promising frontier in functional neurosurgery.

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Section: Discussionmentioning

confidence: 99%

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Mohammed

Patra

Nanda

2018

Neurosurgical Focus

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“…14,18,24,29,38 Huss et al demonstrated no difference in the change in reported QOL between bilateral Vim DBS and unilateral procedures, including DBS and MRgFUS thalamotomy. 22 A randomized controlled study of MRgFUS thalamotomy described significant reductions of 46% in QUEST scores from baseline to 3 months after ablation as compared with a 3% reduction in the sham group.…”

Section: Figmentioning

confidence: 99%

“…14,34,38,40 In patients with ET, it has been suggested that there are complex, widespread alterations of white mater fiber integrity in both motor and nonmotor networks. 25 Thus, theoretically, thalamic procedures can produce disruption in the neuroanatomical pathway connecting the prefrontal cortex and subcortical areas, resulting in frontal lobe dysfunction.…”

Section: Figmentioning

confidence: 99%

“…And certainly, there have been some studies with positive results of DBS in enhancing visuoperceptual or verbal memory function or in causing no significant effects on higher cognitive function even in the long term. 14,19,38 However, DBS has also caused cognitive side effects, such as those related to language, visual memory, and verbal fluency. 7,38 Interestingly, there has been a report of a subtle diminution in verbal memory in the DBS-on state versus the DBS-off state.…”

Section: Figmentioning

confidence: 99%

“…14,19,38 However, DBS has also caused cognitive side effects, such as those related to language, visual memory, and verbal fluency. 7,38 Interestingly, there has been a report of a subtle diminution in verbal memory in the DBS-on state versus the DBS-off state. 27 In the present study, we demonstrated that postoperative cognitive decline could be minimized by thalamic lesioning with MRgFUS.…”

Section: Figmentioning

confidence: 99%

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Effects on cognition and quality of life with unilateral magnetic resonance–guided focused ultrasound thalamotomy for essential tremor

Jung

Park

Chang

et al. 2018

Neurosurgical Focus

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OBJECTIVEAlthough neurosurgical procedures are effective treatments for controlling involuntary tremor in patients with essential tremor (ET), they can cause cognitive decline, which can affect quality of life (QOL). The purpose of this study is to assess the changes in the neuropsychological profile and QOL of patients following MR-guided focused ultrasound (MRgFUS) thalamotomy for ET.METHODSThe authors prospectively analyzed 20 patients with ET who underwent unilateral MRgFUS thalamotomy at their institute in the period from March 2012 to September 2014. Patients were regularly evaluated with the Clinical Rating Scale for Tremor (CRST), neuroimaging, and cognition and QOL measures. The Seoul Neuropsychological Screening Battery was used to assess cognitive function, and the Quality of Life in Essential Tremor Questionnaire (QUEST) was used to evaluate the postoperative change in QOL.RESULTSThe total CRST score improved by 67.3% (from 44.75 ± 9.57 to 14.65 ± 9.19, p < 0.001) at 1 year following MRgFUS thalamotomy. Mean tremor scores improved by 68% in the hand contralateral to the thalamotomy, but there was no significant improvement in the ipsilateral hand. Although minimal cognitive decline was observed without statistical significance, memory function was much improved (p = 0.031). The total QUEST score also showed the same trend of improving (64.16 ± 17.75 vs 27.38 ± 13.96, p < 0.001).CONCLUSIONSThe authors report that MRgFUS thalamotomy had beneficial effects in terms of not only tremor control but also safety for cognitive function and QOL. Acceptable postoperative changes in cognition and much-improved QOL positively support the clinical significance of MRgFUS thalamotomy as a new, favorable surgical treatment in patients with ET.

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Essential Tremor

Benito‐León

Louis

2011

Hyperkinetic Movement Disorders

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Neuropsychological and quality of life outcome after thalamic stimulation for essential tremor

Cited by 140 publications

References 37 publications

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

A meta-analysis of outcomes and complications of magnetic resonance–guided focused ultrasound in the treatment of essential tremor

Effects on cognition and quality of life with unilateral magnetic resonance–guided focused ultrasound thalamotomy for essential tremor

Essential Tremor

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