Transcranial MRI‐guided high‐intensity focused ultrasound for treatment of essential tremor: A pilot study on the correlation between lesion size, lesion location, thermal dose, and clinical outcome

Federau, Christian; Goubran, Maged; Rosenberg, Jarrett; Henderson, Jaimie M.; Halpern, Casey H.; Santini, Veronica; Wintermark, Max; Pauly, Kim Butts; Ghanouni, Pejman

doi:10.1002/jmri.25878

Cited by 45 publications

(35 citation statements)

References 34 publications

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“…Because the first publication of favorable clinical results of MRgFUS thalamotomy in 2013, 5 a few additional reports have been provided regarding its results, 10,11 technical methods, 12 adverse effects, 13 and comparative outcomes with other therapeutic modalities 14 ; however, these studies have primarily been short term. 5,6,[9][10][11]15 With this treatment, the 12-month reduction rate of total CRST was 35% to 56%, hand tremor reduction rate was 40% to 78%, and disability reduction rate was 61% to 85% ( Table 2). We have now shown a 56% reduction rate for 4-year outcome of hand tremor treatment and a 63% reduction rate for disability related to hand tremor, both of which were comparable to the 12-month outcomes.…”

Section: Four-year Results Of Mrgfus Thalamotomymentioning

confidence: 97%

“…MRgFUS thalamotomy has emerged as an additional option for disabling ET. Because the first publication of favorable clinical results of MRgFUS thalamotomy in 2013, a few additional reports have been provided regarding its results, technical methods, adverse effects, and comparative outcomes with other therapeutic modalities; however, these studies have primarily been short term . With this treatment, the 12‐month reduction rate of total CRST was 35% to 56%, hand tremor reduction rate was 40% to 78%, and disability reduction rate was 61% to 85% (Table ).…”

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: Four-year Results Of Mrgfus Thalamotomymentioning

confidence: 97%

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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“…Imaging methods such as MRI diffusion tensor imaging tractography are under investigation to improve targeting for both FUS and DBS . Analyses of postprocedure MRI changes are also under study to improve outcome of sonication‐based ablation …”

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confidence: 99%

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

et al. 2018

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“…A randomized sham‐controlled trial showed a 47% reduction in the tremor subscore of the Clinical Rating Scale for Tremor (CRST) 1 year after treatment . Although a recent follow‐up of this pivotal trial reported a persistent 55% reduction in dominant tremor score at 2 years, how MRgFUS compares to other techniques in the long‐term is unclear given other studies, albeit of short‐term follow‐up and smaller sample size, describe consistent lesion shrinkage and loss of effect over time …”

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confidence: 99%

“…Our primary objective is to describe the long‐term outcome in tremor reduction after MRgFUS thalamotomy with an additional goal of assessing the association between initial lesion volume and sustained benefit from treatment. Finally, few studies have examined what are predictors of treatment efficacy . We hypothesize lesion volume is associated with long‐term benefit and explore this with multivariable linear regression analysis.…”

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Magnetic resonance–guided focused ultrasound thalamotomy for treatment of essential tremor: A 2‐year outcome study

et al. 2018

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A BS TRACT: Background: Magnetic resonanceguided focused ultrasound is an emerging, minimally invasive thermoablation technique for medically refractory essential tremor. Beyond the initial year, data regarding efficacy and potential predictors of efficacy are still preliminary. Objectives: The objective of this study was to assess the outcome at 2 years and the association between lesion volume and outcome 1 year after treatment. Methods: We reviewed data from 37 patients who underwent unilateral magnetic resonance-guided focused ultrasound thalamotomy, with primary outcome being dominant tremor subscore of the Clinical Rating Scale for Tremor. We used multivariable linear regression to model initial lesion volume with 1-year outcome, adjusting for other clinically relevant variables. Results: Although we detected a trend in loss of clinical benefit within the first year, the dominant tremor score at 2 years continued to be significantly improved (43.4%, 95% confidence interval 27.8%-59.0%) from baseline. Secondarily, initial lesion volume is significantly associated with 1-year outcome. Conclusion: Our findings show that magnetic resonance-guided focused ultrasound thalamotomy results in sustained tremor reduction for medically refractory essential tremor even in the long term, and we highlight areas for improvement.

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Transcranial MRI‐guided high‐intensity focused ultrasound for treatment of essential tremor: A pilot study on the correlation between lesion size, lesion location, thermal dose, and clinical outcome

Abstract: 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2017.

Cited by 45 publications

References 34 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

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

Magnetic resonance–guided focused ultrasound thalamotomy for treatment of essential tremor: A 2‐year outcome study

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