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Somatosensory temporal discrimination in Parkinson’s disease, dystonia and essential tremor: Pathophysiological and clinical implications. Clin Neurophysiol 2018; 129:1849-1853. [DOI: 10.1016/j.clinph.2018.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022]
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Lee CY, Yoon JH, Park JH, Hong JY, Sunwoo MK, Kang SY. Uric acid level may not be reduced in essential tremor. Int J Neurosci 2018; 128:1163-1167. [PMID: 29936882 DOI: 10.1080/00207454.2018.1492574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Essential tremor is very common, but characterization is difficult because of its heterogeneity. Neuropathology is important to elucidate the characteristics of neurological disorders. However, pathological findings in essential tremor have been inconsistent among studies. Uric acid is a strong antioxidant and might be a biomarker in neurodegenerative process. We hypothesized that uric acid level would be reduced if essential tremor is a neurodegenerative disease. Our aim was to compare uric acid level between essential tremor patients and healthy individuals. METHODS This was a prospective, case-control, multicenter study with 92 essential tremor patients and 77 healthy subjects. For homogeneity, the essential tremor group was subdivided into two groups (hereditary and sporadic). Clinical and laboratory findings were compared among the essential tremor and healthy groups. RESULTS The demographic characteristics were comparable among the groups. The uric acid level was lower in the essential tremor group than in healthy subjects, but the difference did not reach statistical significance. There was a negative correlation between uric acid level and disease duration in the hereditary group (p = .046) and between uric acid level and age at onset in the sporadic group (p = .012). The mean values of total cholesterol were significantly lower in the sporadic group than in the other groups (p = .011). Total cholesterol was positively correlated with age at onset in the hereditary essential tremor group (p = .010). CONCLUSIONS We did not find any evidence that uric acid levels suggested essential tremor is a neurodegenerative disease. However, further research with more patients might be needed given the negative correlations of disease duration and age at onset with uric acid level.
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Affiliation(s)
- Chae Young Lee
- a Department of Neurology Dongtan Sacred Heart Hospital , Hallym University College of Medicine , Hwaseong , Republic of Korea
| | - Jung Han Yoon
- b Department of Neurology , Ajou University School of Medicine , Suwon , Republic of Korea
| | - Jeong-Ho Park
- c Department of Neurology, College of Medicine , Soonchunhyang University Bucheon Hospital , Bucheon , Republic of Korea
| | - Jin Yong Hong
- d Department of Neurology , Yonsei University Wonju College of Medicine , Wonju , Republic of Korea
| | - Mun Kyung Sunwoo
- e Department of Neurology , Bundang Jesaeng General Hospital , Seongnam , Republic of Korea
| | - Suk Yun Kang
- a Department of Neurology Dongtan Sacred Heart Hospital , Hallym University College of Medicine , Hwaseong , Republic of Korea
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Neuroimaging in Parkinson's disease: focus on substantia nigra and nigro-striatal projection. Curr Opin Neurol 2018; 30:416-426. [PMID: 28537985 DOI: 10.1097/wco.0000000000000463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW The diagnosis of Parkinson disease is based on clinical features; however, unmet need is an imaging signature for Parkinson disease and the early differential diagnosis with atypical parkinsonisms. A summary of the molecular imaging and MRI recent evidences for Parkinson disease diagnosis will be presented in this review. RECENT FINDINGS The nigro-striatal dysfunction explored by dopamine transporter imaging is not a mandatory diagnostic criterion for Parkinson disease, recent evidence supported its utility as in-vivo proof of degenerative parkinsonisms, and there might be compensatory mechanisms leading to an early overestimation. The visualization of abnormalities in substantia nigra by MRI has been recently described as sensitive and specific tool for Parkinson disease diagnosis, even in preclinical conditions, whereas it is not useful for distinguishing between Parkinson disease and atypical parkinsonisms. The relationship between the nigral anatomical changes, evaluated as structural alterations or neuromelanin signal decrease and the dopaminergic nigro-striatal function needs to be further clarified. SUMMARY With the hopeful advent of potential neuroprotective drugs for PD, it is crucial to have imaging measures that are able to detect at risk subjects. Moreover it is desirable to increase the knowledge about which measure better predicts the probability and the time of clinical conversion to PD.
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Abstract
INTRODUCTION Essential tremor is the most common form of pathologic tremor. Surgical therapies disrupt tremorogenic oscillation in the cerebellothalamocortical pathway and are capable of abolishing severe tremor that is refractory to available pharmacotherapies. Surgical methods are raspidly improving and are the subject of this review. Areas covered: A PubMed search on 18 January 2018 using the query essential tremor AND surgery produced 839 abstracts. 379 papers were selected for review of the methods, efficacy, safety and expense of stereotactic deep brain stimulation (DBS), stereotactic radiosurgery (SRS), focused ultrasound (FUS) ablation, and radiofrequency ablation of the cerebellothalamocortical pathway. Expert commentary: DBS and SRS, FUS and radiofrequency ablations are capable of reducing upper extremity tremor by more than 80% and are far more effective than any available drug. The main research questions at this time are: 1) the relative safety, efficacy, and expense of DBS, SRS, and FUS performed unilaterally and bilaterally; 2) the relative safety and efficacy of thalamic versus subthalamic targeting; 3) the relative safety and efficacy of atlas-based versus direct imaging tractography-based anatomical targeting; and 4) the need for intraoperative microelectrode recordings and macroelectrode stimulation in awake patients to identify the optimum anatomical target. Randomized controlled trials are needed.
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Affiliation(s)
- Rodger J Elble
- a Neuroscience Institute , Southern Illinois University School of Medicine , Springfield , Illinois , USA
| | - Ludy Shih
- b Department of Neurology , Beth Israel Deaconess Medical Center, Harvard Medical School , Boston , Massachusetts USA
| | - Jeffrey W Cozzens
- a Neuroscience Institute , Southern Illinois University School of Medicine , Springfield , Illinois , USA
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Abstract
Botulinum neurotoxins (BoNTs) are now among the most widely used therapeutic agents in clinical medicine with indications applied to the fields of movement disorders, pain disorders, and autonomic dysfunction. In this literature review, the efficacy and utility of BoNTs in the field of movement disorders are assessed using the criteria of the Guideline Development Subcommittee of the American Academy of Neurology. The literature supports a level A efficacy (established) for BoNT therapy in cervical dystonia and a level B efficacy (probably effective) for blepharospasm, hemifacial spasm, laryngeal dystonia (spasmodic dysphonia), task-specific dystonias, essential tremor, and Parkinson rest tremor. It is the view of movement disorder experts, however, that despite the level B efficacy, BoNTs should be considered treatment of first choice for blepharospasm, hemifacial spasm, laryngeal, and task-specific dystonias. The emerging data on motor and vocal tics of Tourette syndrome and oromandibular dystonias are encouraging but the current level of efficacy is U (undetermined) due to lack of published high-quality studies.
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Affiliation(s)
- Yasaman Safarpour
- Division of Nephrology, Department of Medicine, University of California, Irvine, USA
| | - Bahman Jabbari
- Division of Movement Disorders, Department of Neurology, Yale University School of Medicine, New Haven-CT, 31 Silver Pine Drive, Newport Coast, CA, 92657, USA.
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Algarni M, Fasano A. The overlap between Essential tremor and Parkinson disease. Parkinsonism Relat Disord 2018; 46 Suppl 1:S101-S104. [DOI: 10.1016/j.parkreldis.2017.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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Fasano A, Lang AE, Espay AJ. What is "essential" about essential tremor? A diagnostic placeholder. Mov Disord 2017; 33:58-61. [PMID: 29272067 DOI: 10.1002/mds.27288] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023] Open
Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
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58
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Is there even such a thing as “idiopathic normal pressure hydrocephalus”? Ann Neurol 2017; 82:1032. [DOI: 10.1002/ana.25097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/26/2017] [Indexed: 12/14/2022]
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Espay AJ, Maloney T, Vannest J, Norris MM, Eliassen JC, Neefus E, Allendorfer JB, Lang AE, Szaflarski JP. Impaired emotion processing in functional (psychogenic) tremor: A functional magnetic resonance imaging study. NEUROIMAGE-CLINICAL 2017; 17:179-187. [PMID: 29085776 PMCID: PMC5655406 DOI: 10.1016/j.nicl.2017.10.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/13/2017] [Accepted: 10/18/2017] [Indexed: 02/06/2023]
Abstract
Background Despite its high prevalence and associated disability, the neural correlates of emotion processing in patients with functional (psychogenic) tremor (FT), the most common functional movement disorder, remain poorly understood. Methods In this cross sectional functional magnetic resonance imaging (fMRI) study at 4T, 27 subjects with FT, 16 with essential tremor (ET), and 25 healthy controls (HCs) underwent a finger-tapping motor task, a basic-emotion task, and an intense-emotion task to probe motor and emotion circuitries. Anatomical and functional MRI data were processed with FSL (FMRIB Software Library) and AFNI (Analysis of Functional Neuroimages), followed by seed-to-seed connectivity analyses using anatomical regions defined from the Harvard-Oxford subcortical atlas; all analyses were corrected for multiple comparisons. Results After controlling for depression scores and correcting for multiple comparisons, the FT group showed increased activation in the right cerebellum compared to ET during the motor task; and increased activation in the paracingulate gyrus and left Heschl's gyrus compared with HC with decreased activation in the right precentral gyrus compared with ET during the basic-emotion task. No significant differences were found after adjusting for multiple comparisons during the intense-emotion task but increase in connectivity between the left amygdala and left middle frontal gyrus survived corrections in the FT subjects during this task, compared to HC. Conclusions In response to emotional stimuli, functional tremor is associated with alterations in activation and functional connectivity in networks involved in emotion processing and theory of mind. These findings may be relevant to the pathophysiology of functional movement disorders. Patients with functional tremor exhibit altered emotion processing circuitry. There is increased activation in the paracingulate gyrus after emotional stimuli. Increased connectivity between the left amygdala and middle frontal gyrus Functional disorders may be associated with disturbances in the theory of mind.
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Key Words
- AFNI, Analysis of Functional Neuroimages
- CPT-END, continuous performance task with emotional and neutral distracters
- Conversion disorder
- EPI, echo-planar imaging
- Emotion processing
- FSL, FMRIB Software Library
- FT, functional tremor
- Functional movement disorders
- Functional tremor
- HAM-A, Hamilton Anxiety Rating Scale
- HAM-D, Hamilton Depression Rating Scale
- MDEFT, modified equilibrium Fourier transform
- MINI, Mini International Neuropsychiatric Interview
- Psychogenic tremor
- fMRI
- fMRI, functional magnetic resonance imaging
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Affiliation(s)
- Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA.
| | - Thomas Maloney
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Jennifer Vannest
- Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Matthew M Norris
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, OH, USA
| | - James C Eliassen
- University of Cincinnati Center for Imaging Research (CIR), Cincinnati, OH, USA
| | - Erin Neefus
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Cincinnati, OH, USA
| | - Jane B Allendorfer
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anthony E Lang
- The Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, University of Toronto, Toronto, Canada
| | - Jerzy P Szaflarski
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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Pandey S, Sarma N. Tremor in Dystonia: A Cross-sectional Study from India. Mov Disord Clin Pract 2017; 4:858-863. [PMID: 30868097 DOI: 10.1002/mdc3.12546] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/23/2017] [Accepted: 09/02/2017] [Indexed: 12/14/2022] Open
Abstract
Background Tremor is an important phenotypic motor feature in dystonia, but there is limited literature regarding its prevalence and phenomenology. Methods This cross-sectional study included 90 patients with adult-onset, isolated dystonia from a tertiary care movement disorder center in India. Patients were assessed for tremor in the head and in different body parts. Surface electromyography studies of tremor were recorded of the involved limb in different positions. Results Tremor was present in 41 patients (45.55%) who had dystonia, including 21 of 41 patients (51.21%) with cervical dystonia, 15 of 34 (44.11%) with limb dystonia, and 5 of 15 (33.33%) with cranial dystonia. Significantly later age at presentation (47.19 ± 14.55 years vs. 40.39 ± 13.74 years; P = 0.012) and longer disease duration (5.11 ± 5.85 years vs. 2.60 ± 2.57 years; P = 0.004) were observed in patients with versus without tremor. Upper limb tremor was present in 33 patients, head tremor was present in 14, and leg tremor was present in 2. Tremor was present in 17 of 25 patients (68%) with segmental dystonia and in 6 of 9 (66.66%) with multifocal dystonia. Tremor was least frequent in patients with focal dystonia (18 of 56 patients; 32.14%). Conclusions Tremor was common (>45%) in patients with primary adult-onset dystonia. Patients who had tremor were older and had a longer duration of symptoms. Patients with segmental and multifocal dystonia had more tremor than those with focal dystonia. In contrast to some other studies, the current patients had more upper limb tremor than head tremor, and a combination of dystonic tremor and tremor associated with dystonia was more common than isolated dystonic tremor.
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Affiliation(s)
- Sanjay Pandey
- Department of Neurology Govind Ballabh Pant Postgraduate Institute of Medical Education and Research New Delhi India
| | - Neelav Sarma
- Department of Neurology Govind Ballabh Pant Postgraduate Institute of Medical Education and Research New Delhi India
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Zesiewicz TA, Sullivan KL, Ponce de Leon M, Bennett A, Hohler AD. Quality improvement in neurology: Essential Tremor Quality Measurement Set. Neurology 2017; 89:1291-1295. [PMID: 28835402 DOI: 10.1212/wnl.0000000000004372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 06/28/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Theresa A Zesiewicz
- From the Department of Neurology (T.A.Z.), University of South Florida; James A Haley Veterans Administration Hospital (T.A.Z.), Tampa, FL; Department of Epidemiology (K.L.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; Department of Neurology (M.P.d.L.), Madigan Army Medical Center, Tacoma, WA; American Academy of Neurology (A.B.), Minneapolis, MN; and Department of Neurology (A.D.H.), Boston University School of Medicine/BMC, MA
| | - Kelly L Sullivan
- From the Department of Neurology (T.A.Z.), University of South Florida; James A Haley Veterans Administration Hospital (T.A.Z.), Tampa, FL; Department of Epidemiology (K.L.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; Department of Neurology (M.P.d.L.), Madigan Army Medical Center, Tacoma, WA; American Academy of Neurology (A.B.), Minneapolis, MN; and Department of Neurology (A.D.H.), Boston University School of Medicine/BMC, MA
| | - Marcus Ponce de Leon
- From the Department of Neurology (T.A.Z.), University of South Florida; James A Haley Veterans Administration Hospital (T.A.Z.), Tampa, FL; Department of Epidemiology (K.L.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; Department of Neurology (M.P.d.L.), Madigan Army Medical Center, Tacoma, WA; American Academy of Neurology (A.B.), Minneapolis, MN; and Department of Neurology (A.D.H.), Boston University School of Medicine/BMC, MA
| | - Amy Bennett
- From the Department of Neurology (T.A.Z.), University of South Florida; James A Haley Veterans Administration Hospital (T.A.Z.), Tampa, FL; Department of Epidemiology (K.L.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; Department of Neurology (M.P.d.L.), Madigan Army Medical Center, Tacoma, WA; American Academy of Neurology (A.B.), Minneapolis, MN; and Department of Neurology (A.D.H.), Boston University School of Medicine/BMC, MA.
| | - Anna D Hohler
- From the Department of Neurology (T.A.Z.), University of South Florida; James A Haley Veterans Administration Hospital (T.A.Z.), Tampa, FL; Department of Epidemiology (K.L.S.), Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro; Department of Neurology (M.P.d.L.), Madigan Army Medical Center, Tacoma, WA; American Academy of Neurology (A.B.), Minneapolis, MN; and Department of Neurology (A.D.H.), Boston University School of Medicine/BMC, MA
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Differential Diagnosis of Parkinson Disease, Essential Tremor, and Enhanced Physiological Tremor with the Tremor Analysis of EMG. PARKINSONS DISEASE 2017; 2017:1597907. [PMID: 28884038 PMCID: PMC5573102 DOI: 10.1155/2017/1597907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/12/2017] [Indexed: 11/25/2022]
Abstract
We investigate the differential diagnostic value of tremor analysis of EMG on Parkinson's disease (PD), essential tremor (ET), and enhanced physiological tremor (EPT). Clinical data from 25 patients with PD, 20 patients with ET, and 20 patients with EPT were collected. The tremor frequency and muscle contraction pattern of the resting, posture, and 500 g and 1000 g overload were recorded. The frequency of PD tremor was 4–6 Hz, and the frequency of ET was also in this range; the frequency of EPT is 6–12 hz having some overlap with PD. The muscle contraction patterns of the ET and EPT group were mainly synchronous contraction, and the muscle contraction mode of the PD group was mainly alternating contraction. Having tremor latency from rest to postural position and having changes in tremor amplitude after mental concentration in PD might distinguish ET. Tremor analysis of EMG was able to distinguish PD from ET and EPT by varying the tremor frequency and muscle contraction pattern. It can also differentiate between PD and ET by the latency and concentration effect and ET and EPT by weight load effect.
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Rohani M, Fasano A. Focused Ultrasound for Essential Tremor: Review of the Evidence and Discussion of Current Hurdles. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:462. [PMID: 28503363 PMCID: PMC5425801 DOI: 10.7916/d8z89jn1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/17/2017] [Indexed: 01/09/2023]
Abstract
Background While there is no breakthrough progress in the medical treatment of essential tremor (ET), in the past decades several remarkable achievements happened in the surgical field, such as radiofrequency thalamotomy, thalamic deep brain stimulation, and gamma knife thalamotomy. The most recent advance in this area is magnetic resonance-guided focused ultrasound (MRgFUS). Methods The purpose of this review is to discuss the new developments and trials of MRgFUS in the treatment of ET and other tremor disorders. Results MRgFUS is an incisionless surgery performed without anesthesia and ionizing radiation (no risk of cumulative dose and delayed side effects). Studies have shown the safety and effectiveness of unilateral MRgFUS-thalamotomy in the treatment of ET. It has been successfully used in a few patients with Parkinson’s disease-related tremor, and in fewer patients with fragile X-associated tremor/ataxia syndrome. The safety and long-term effects of the procedure are still unclear, as temporary and permanent adverse events have been reported as well as recurrence of tremor. Discussion MRgFUS is a promising new surgical approach with a number of unknowns and unsolved issues. It represents a valuable option particularly for patients who refused or could not be candidates for other procedures, deep brain stimulation in particular.
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Affiliation(s)
- Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
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