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Cammaroto S, Acri G, Hartwig V, Morabito R, Militi A, Smorto C, Ielo A, Bonanno L, Anfuso C, Quartarone A. Could the Anatomic Variants of the Superior Thalamic Vein (STV) Be Considered a Possible Landmark for Target Identification in Magnetic-Resonance-Guided Focused Ultrasound Procedures? A Pilot Study Using Susceptibility Weighted Imaging Sequences. Diagnostics (Basel) 2024; 14:1409. [PMID: 39001299 PMCID: PMC11240953 DOI: 10.3390/diagnostics14131409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
During magnetic-resonance-guided focused ultrasound ablation of the ventral intermediate thalamic nucleus (VIM) for essential tremor (ET) and Parkinson's disease (PD), targeting is generally performed using a standard atlas-based stereotactic approach. The purpose of our work is to evaluate the anatomic variations in the venous vasculature of the thalamus in patients treated with MRgFUS, as a possible landmark for targeting. We retrospectively evaluated the relationship between the obtained thalamotomy lesion and the ipsilateral superior thalamic vein (STV). A total of 36 patients (25 ET and 11 PD) who underwent MRgFUS treatment were evaluated, and the STV was studied with susceptibility weighted imaging (SWI) sequences. Based on the axial SWI images, the distance between the STV and the center of the lesion at the presumed site of the VIM was measured in follow-up MRI images one month after treatment. Statistical analysis shows that there is a correlation between the STV and the presumed site of the VIM. The STV visible in SWI could be used as an additional, real-time, and patient-specific anatomical landmark for VIM identification during MR examination and just before and during FUS treatment.
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Affiliation(s)
- Simona Cammaroto
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Giuseppe Acri
- Dipartimento di Scienze Biomediche, Odontoiatriche e Delle Immagini Morfologiche e Funzionali, Università degli Studi di Messina, c/o A.O.U. Policlinico “G. Martino”, 98125 Messina, Italy
| | - Valentina Hartwig
- Institute of Clinical Physiology, National Research Council—CNR, 56124 Pisa, Italy
| | - Rosa Morabito
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Annalisa Militi
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Chiara Smorto
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Augusto Ielo
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Lilla Bonanno
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Carmelo Anfuso
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
| | - Angelo Quartarone
- IRCCS Centro Neurolesi “Bonino Pulejo”, 98124 Messina, Italy; (S.C.); (R.M.); (A.M.); (C.S.); (A.I.); (L.B.); (C.A.); (A.Q.)
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Arcadi A, Aviles-Olmos I, Gonzalez-Quarante LH, Gorospe A, Jiménez-Huete A, de la Corte MM, Parras O, Martin-Bastida A, Riverol M, Villino R, Guridi J, Rodríguez-Oroz MC. Magnetic Resonance-Guided Focused Ultrasound (MRgFUS)-Thalamotomy for Essential Tremor: Lesion Location and Clinical Outcomes. Mov Disord 2024; 39:1015-1025. [PMID: 38616324 DOI: 10.1002/mds.29801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Factors predicting clinical outcomes after MR-guided focused ultrasound (MRgFUS)-thalamotomy in patients with essential tremor (ET) are not well known. OBJECTIVE To examine the clinical outcomes and their relationship with patients' baseline demographic and clinical features and lesion characteristics at 6-month follow-up in ET patients. METHODS A total of 127 patients were prospectively evaluated at 1 (n = 122), 3 (n = 102), and 6 months (n = 78) after MRgFUS-thalamotomy. Magnetic resonance imaging (MRI) was obtained at 6 months (n = 60). Primary outcomes included: (1) change in the Clinical Rating Scale of Tremor (CRST)-A+B score in the treated hand and (2) frequency and severity of adverse events (AEs) at 6 months. Secondary outcomes included changes in all subitems of the CRST scale in the treated hand, CRST-C, axial tremor (face, head, voice, tongue), AEs, and correlation of primary outcomes at 6 months with lesion characteristics. Statistical analysis included linear mixed, standard, and logistic regression models. RESULTS Scores for CRST-A+B, CRST-A, CRST-B in the treated hand, CRST-C, and axial tremor were improved at each evaluation (P < 0.001). Five patients had severe AEs at 1 month that became mild throughout the follow-up. Mild AEs occurred in 71%, 45%, and 34% of patients at 1, 3, and 6 months, respectively. Lesion volume was associated with the reduction in the CRST-A (P = 0.003) and its overlapping with the ventralis intermedius nucleus (Vim) nucleus with the reduction in CRST-A+B (P = 0.02) and CRST-B (P = 0.008) at 6 months. CONCLUSIONS MRgFUS-thalamotomy improves hand and axial tremor in ET patients. Transient and mild AEs are frequent. Lesion volume and location are associated with tremor reduction. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alana Arcadi
- Neurosurgery Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Iciar Aviles-Olmos
- Neurology Department, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | - Arantza Gorospe
- Neurology Department, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | | | | | - Olga Parras
- Hospital Universitario Alava, Vitoria-Gasteiz, Spain
| | | | - Mario Riverol
- Neurology Department, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Rafael Villino
- Neurology Department, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Jorge Guridi
- Neurosurgery Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Maria C Rodríguez-Oroz
- Neurology Department, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
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Kyle K, Peters J, Jonker B, Barnett Y, Maamary J, Barnett M, Maller J, Wang C, Tisch S. Magnetic Resonance-Guided Focused Ultrasound for Treatment of Essential Tremor: Ventral Intermediate Nucleus Ablation Alone or Additional Posterior Subthalamic Area Lesioning? Mov Disord Clin Pract 2024; 11:504-514. [PMID: 38469997 PMCID: PMC11078489 DOI: 10.1002/mdc3.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/18/2023] [Accepted: 01/24/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) for treatment of essential tremor (ET) traditionally targets the ventral intermediate (Vim) nucleus. Recent strategies include a secondary lesion to the posterior subthalamic area (PSA). OBJECTIVE The aim was to compare lesion characteristics, tremor improvement, and adverse events (AE) between patients in whom satisfactory tremor suppression was achieved with lesioning of the Vim alone and patients who required additional lesioning of the PSA. METHODS Retrospective analysis of data collected from ET patients treated with MRgFUS at St Vincent's Hospital Sydney was performed. Clinical Rating Scale for Tremor (CRST), hand tremor score (HTS), and Quality of Life in Essential Tremor Questionnaire (QUEST) were collected pre- and posttreatment in addition to the prevalence of AEs. The lesion coordinates and overlap with the dentatorubrothalamic tract (DRTT) were evaluated using magnetic resonance imaging. RESULTS Twenty-one patients were treated in Vim only, and 14 were treated with dual Vim-PSA lesions. Clinical data were available for 29 of the 35 patients (19 single target and 10 dual target). At follow-up (mean: 18.80 months) HTS, CRST, and QUEST in single-target patients improved by 57.97% (P < 0.001), 36.71% (P < 0.001), and 58.26% (P < 0.001), whereas dual-target patients improved by 68.34% (P < 0.001), 35.37% (P < 0.003), and 46.97% (P < 0.005), respectively. The Vim lesion of dual-target patients was further anterior relative to the posterior commissure (PC) (7.84 mm), compared with single-target patients (6.92 mm), with less DRTT involvement (14.85% vs. 23.21%). Dual-target patients exhibited a greater proportion of patients with acute motor AEs (100% vs. 58%); however, motor AE prevalence was similar in both groups at long-term follow-up (33% vs. 38%). CONCLUSION Posterior placement of lesions targeting the Vim may confer greater tremor suppression. The addition of a PSA lesion, in patients with inadequate tremor control despite Vim lesioning, had a trend toward better long-term tremor suppression; however, this approach was associated with greater prevalence of gait disturbance in the short term.
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Affiliation(s)
- Kain Kyle
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
| | - James Peters
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Benjamin Jonker
- Department of NeurosurgerySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- Royal Prince Alfred Institute of Academic SurgeryUniversity of SydneyCamperdownNew South WalesAustralia
| | - Yael Barnett
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- Department of Medical ImagingSt Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Joel Maamary
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Michael Barnett
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | | | - Chenyu Wang
- Faculty of Medicine and Health Translational Research CollectiveThe University of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreThe University of SydneySydneyNew South WalesAustralia
- Sydney Neuroimaging Analysis CentreCamperdownNew South WalesAustralia
| | - Stephen Tisch
- Department of NeurologySt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
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Tamburin S, Paio F, Bovi T, Bulgarelli G, Longhi M, Foroni R, Mantovani E, Polloniato PM, Tagliamonte M, Zivelonghi E, Zucchella C, Cavedon C, Nicolato A, Petralia B, Sala F, Bonetti B, Tinazzi M, Montemezzi S, Ricciardi GK. Magnetic resonance-guided focused ultrasound unilateral thalamotomy for medically refractory essential tremor: 3-year follow-up data. Front Neurol 2024; 15:1360035. [PMID: 38737350 PMCID: PMC11082386 DOI: 10.3389/fneur.2024.1360035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
Introduction Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy of the ventralis intermediate (Vim) nucleus is an "incisionless" treatment for medically refractory essential tremor (ET). We present data on 49 consecutive cases of MRgFUS Vim thalamotomy followed-up for 3 years and review the literature on studies with longer follow-up data. Methods A retrospective chart review of patients who underwent MRgFUS thalamotomy (January 2018-December 2020) at our institution was performed. Clinical Rating Scale for Tremor (CRST) and Quality of Life in Essential Tremor (QUEST) scores were obtained pre-operatively and at each follow-up with an assessment of side effects. Patients had post-operative magnetic resonance imaging within 24 h and at 1 month to figure out lesion location, size, and extent. The results of studies with follow-up ≥3 years were summarized through a literature review. Results The CRST total (baseline: 58.6 ± 17.1, 3-year: 40.8 ± 18.0) and subscale scores (A + B, baseline: 23.5 ± 6.3, 3-year: 12.8 ± 7.9; C, baseline: 12.7 ± 4.3, 3-year: 5.8 ± 3.9) and the QUEST score (baseline: 38.0 ± 14.8, 3-year: 18.7 ± 13.3) showed significant improvement that was stable during the 3-year follow-up. Three patients reported tremor recurrence and two were satisfactorily retreated. Side effects were reported by 44% of patients (severe: 4%, mild and transient: 40%). The improvement in tremor and quality of life in our cohort was consistent with the literature. Conclusion We confirmed the effectiveness and safety of MRgFUS Vim thalamotomy in medically refractory ET up to 3 years.
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Affiliation(s)
- Stefano Tamburin
- Neurology Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Neurology Section, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Fabio Paio
- Neurology Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Neurology Section, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Tommaso Bovi
- Neurology Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giorgia Bulgarelli
- Stereotactic Neurosurgery and Radiosurgery Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Longhi
- Stereotactic Neurosurgery and Radiosurgery Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Roberto Foroni
- Stereotactic Neurosurgery and Radiosurgery Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Medical Physics Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elisa Mantovani
- Neurology Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Neurology Section, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Paolo Maria Polloniato
- Medical Physics Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Micaela Tagliamonte
- Neuroradiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emanuele Zivelonghi
- Medical Physics Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Chiara Zucchella
- Neurology Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Carlo Cavedon
- Medical Physics Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Antonio Nicolato
- Stereotactic Neurosurgery and Radiosurgery Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Benedetto Petralia
- Neuroradiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Francesco Sala
- Neurosurgery Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Neurosurgery Section, Department of Neurosciences, Biomedicine, and Movement Science, University of Verona, Verona, Italy
| | - Bruno Bonetti
- Neurology Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Michele Tinazzi
- Neurology Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
- Neurology Section, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Stefania Montemezzi
- Radiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giuseppe Kenneth Ricciardi
- Neuroradiology Unit, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Ng PR, Blitz SE, Chua MMJ, Cosgrove GR. Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor patients with low skull density ratio: a case-matched analysis. Front Neurol 2024; 15:1370574. [PMID: 38711556 PMCID: PMC11071343 DOI: 10.3389/fneur.2024.1370574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/04/2024] [Indexed: 05/08/2024] Open
Abstract
Introduction Skull density ratio (SDR) is the ratio between the mean Hounsfield units of marrow and cortical bone, impacting energy transmission through the skull. Low SDR has been used as an exclusion criterion in major trials of magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor (ET). However, some studies have suggested that patients with low SDR can safely undergo MRgFUS with favorable outcomes. In this case-matched study, we aim to compare the characteristics, sonication parameters, lesion sizes, and clinical outcomes of patients with low SDR vs. patients with high SDR who underwent unilateral MRgFUS thalamotomy for medication-refractory ET. Methods Between March 2016 and April 2023, all patients (n = 270) who underwent unilateral MRgFUS thalamotomy for medication-refractory ET at a single institution were classified as low SDR (<0.40) and high SDR (≥0.40). All clinical and radiological data was prospectively collected and retrospectively analyzed using non-case-matched and 1:1 case-matched methodology. Results Thirty-one patients had low SDR, and 239 patients had high SDR. Fifty-six patients (28 in each cohort) were included in 1:1 case-matched analysis. There were no significant differences in baseline characteristics between the two groups in both non-case-matched and 1:1 case-matched analyses. In both analyses, compared to patients with high SDR, patients with low SDR required a significantly higher maximum sonication power, energy, and duration, and reached a lower maximum temperature with smaller lesion volumes. In the non-case-matched and case-matched analyses, low SDR patients did not have significantly less tremor control at any postoperative timepoints. However, there was a higher chance of procedure failure in the low SDR group with three patients not obtaining an appropriately sized lesion. In both analyses, imbalance was observed more often in high SDR patients on postoperative day 1 and month 3. Discussion ET patients with SDR <0.40 can be safely and effectively treated with MRgFUS, though there may be higher rates of treatment failure and intraoperative discomfort.
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Affiliation(s)
- Patrick R. Ng
- Department of Neurological Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
| | | | - Melissa M. J. Chua
- Harvard Medical School, Boston, CA, United States
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - G. Rees Cosgrove
- Harvard Medical School, Boston, CA, United States
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
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Jameel A, Akgun S, Yousif N, Smith J, Jones B, Nandi D, Bain P, Gedroyc W. The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation. Front Neurol 2024; 15:1345873. [PMID: 38595847 PMCID: PMC11002122 DOI: 10.3389/fneur.2024.1345873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/23/2024] [Indexed: 04/11/2024] Open
Abstract
Background The ventral intermediate nucleus (VIM) is the premiere target in magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for tremor; however, there is no consensus on the optimal coordinates for ablation. This study aims to ascertain the various international VIM targeting approaches (VIM-TA) and any evolution in practice. Methods International MRgFUS centers were invited to share VIM-TAs in 2019 and 2021. Analyses of any modification in practice and of anatomical markers and/or tractography in use were carried out. Each VIM-TA was mapped in relation to the mid-commissural point onto a 3D thalamic nucleus model created from the Schaltenbrand-Wahren atlas. Results Of the 39 centers invited, 30 participated across the study period, providing VIM-TAs from 26 centers in 2019 and 23 in 2021. The results are reported as percentages of the number of participating centers in that year. In 2019 and 2021, respectively, 96.2% (n = 25) and 95.7% (n = 22) of centers based their targeting on anatomical landmarks rather than tractography. Increased adoption of tractography in clinical practice and/or for research was noted, changing from 34.6% to 78.3%. There was a statistically significant change in VIM-TAs in the superior-inferior plane across the study period; the percentage of VIM-TAs positioned 2 mm above the intercommissural line (ICL) increased from 16.0% in 2019 to 40.9% in 2021 (WRST, p < 0.05). This position is mapped at the center of VIM on the 3D thalamic model created based on the Schaltenbrand-Wahren atlas. In contrast, the VIM-TA medial-lateral and anterior-posterior positions remained stable. In 2022, 63.3% of participating centers provided the rationale for their VIM-TAs and key demographics. The centers were more likely to target 2 mm above the ICL if they had increased experience (more than 100 treatments) and/or if they were North American. Conclusion Across the study period, FUS centers have evolved their VIM targeting superiorly to target the center of the VIM (2 mm above the ICL) and increased the adoption of tractography to aid VIM localization. This phenomenon is observed across autonomous international centers, suggesting that it is a more optimal site for FUS thalamotomy in tremors.
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Affiliation(s)
- Ayesha Jameel
- Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sena Akgun
- Sapienza University of Rome, Rome, Italy
| | - Nada Yousif
- University of Hertfordshire, Hatfield, United Kingdom
| | - Joely Smith
- Imperial College London, London, United Kingdom
| | - Brynmor Jones
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dipankar Nandi
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Peter Bain
- Imperial College London, London, United Kingdom
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Sinai A, Nassar M, Shornikov L, Constantinescu M, Zaaroor M, Schlesinger I. Focused Ultrasound Thalamotomy for Tremor Relief in Atypical Parkisnsonism. PARKINSON'S DISEASE 2024; 2024:6643510. [PMID: 38476865 PMCID: PMC10932618 DOI: 10.1155/2024/6643510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 12/04/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024]
Abstract
Background Magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) VIM-thalamotomy has established efficacy and safety in tremor relief in patients with essential tremor and Parkinson's disease. The efficacy and safety in patients with atypical parkinsonism have not been reported. Objective To report on the efficacy and safety of FUS VIM-thalamotomy in 8 patients with parkinsonism, multiple system atrophy-Parkinsonian type (MSA-P) (n = 5), and dementia with Lewy bodies (DLB) (n = 3). Methods Tremor was assessed in the treated hemibody using the Clinical Rating Scale for Tremor (CRST). The motor Unified MSA Rating Scale (UMSAR) was used in the MSA-P and motor sections of the Unified Parkinson's Disease Rating Scale (UPDRS-III) in DLB patients. Cognition was measured using the Montreal Cognitive Assessment (MoCA). Results In MSA-P and DLB patients, there was immediate tremor relief. CRST scores measured on the treated side improved compared to baseline. During the follow-up of up to 1 year tremor reduction persisted. The change in CRST scores at different time points did not reach statistical significance, probably due to the small sample size. Adverse events were transient and resolved within a year. Conclusions In our experience, FUS VIM-thalamotomy was effective in patients with MSA-P and DLB. Larger, controlled studies are needed to verify our preliminary observations.
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Affiliation(s)
- Alon Sinai
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - Maria Nassar
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Lev Shornikov
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | | | - Menashe Zaaroor
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Ilana Schlesinger
- Department of Neurology, Rambam Health Care Campus, Haifa, Israel
- Technion Faculty of Medicine, Haifa, Israel
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McGill KC, Baal JD, Bucknor MD. Update on musculoskeletal applications of magnetic resonance-guided focused ultrasound. Skeletal Radiol 2024:10.1007/s00256-024-04620-8. [PMID: 38363419 DOI: 10.1007/s00256-024-04620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive, incisionless, radiation-free technology used to ablate tissue deep within the body. This technique has gained increased popularity following FDA approval for treatment of pain related to bone metastases and limited approval for treatment of osteoid osteoma. MRgFUS delivers superior visualization of soft tissue targets in unlimited imaging planes and precision in targeting and delivery of thermal dose which is all provided during real-time monitoring using MR thermometry. This paper provides an overview of the common musculoskeletal applications of MRgFUS along with updates on clinical outcomes and discussion of future applications.
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Affiliation(s)
- Kevin C McGill
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA.
| | - Joe D Baal
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA
| | - Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Suite M391, San Francisco, CA, 94143, USA
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Peters J, Maamary J, Kyle K, Olsen N, Jones L, Bolitho S, Barnett Y, Jonker B, Tisch S. Outcomes of Focused Ultrasound Thalamotomy in Tremor Syndromes. Mov Disord 2024; 39:173-182. [PMID: 37964429 DOI: 10.1002/mds.29658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The current literature comparing outcomes after a unilateral magnetic resonance image-guided focused ultrasound (MRgFUS) thalamotomy between tremor syndromes is limited and remains a possible preoperative factor that could help predict the long-term outcomes. OBJECTIVE The aim was to report on the outcomes between different tremor syndromes after a unilateral MRgFUS thalamotomy. METHODS A total of 66 patients underwent a unilateral MRgFUS thalamotomy for tremor between November 2018 and May 2020 at St Vincent's Hospital Sydney. Each patient's tremor syndrome was classified prior to treatment. Clinical assessments, including the hand tremor score (HTS) and Quality of Life in Essential Tremor Questionnaire (QUEST), were performed at baseline and predefined intervals to 36 months. RESULTS A total of 63 patients, comprising 30 essential tremor (ET), 24 dystonic tremor (DT), and 9 Parkinson's disease tremor (PDT) patients, returned for at least one follow-up. In the ET patients, at 24 months there was a 61% improvement in HTS and 50% improvement in QUEST compared to baseline. This is in comparison to PDT patients, where an initial benefit in HTS and QUEST was observed, which waned at each follow-up, remaining significant only up until 12 months. In the DT patients, similar results were observed to the ET patients: at 24 months there was a 61% improvement in HTS and 43% improvement in QUEST compared to baseline. CONCLUSION These results support the use of unilateral MRgFUS thalamotomy for the treatment of DT, which appears to have a similar expected outcome to patients diagnosed with ET. Patients with PDT should be warned that there is a risk of treatment failure. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- James Peters
- Department of Neurology, St Vincent's Health Network Sydney, Sydney, Australia
- School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Joel Maamary
- Department of Neurology, St Vincent's Health Network Sydney, Sydney, Australia
- School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Kain Kyle
- Sydney Neuroimaging Analysis Centre, Brain and Mind Centre, Sydney, Australia
| | - Nick Olsen
- Stats Central, Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Australia
| | - Lyndsey Jones
- Department of Neurology, St Vincent's Health Network Sydney, Sydney, Australia
| | - Samuel Bolitho
- Department of Neurology, St Vincent's Health Network Sydney, Sydney, Australia
| | - Yael Barnett
- School of Medical Sciences, The University of New South Wales, Sydney, Australia
- Department of Radiology, St Vincent's Health Network Sydney, Sydney, Australia
| | - Benjamin Jonker
- School of Medical Sciences, The University of New South Wales, Sydney, Australia
- Department of Neurosurgery, St Vincent's Health Network, Sydney, Australia
| | - Stephen Tisch
- Department of Neurology, St Vincent's Health Network Sydney, Sydney, Australia
- School of Medical Sciences, The University of New South Wales, Sydney, Australia
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10
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Kondapavulur S, Silva AB, Molinaro AM, Wang DD. A Systematic Review Comparing Focused Ultrasound Surgery With Radiosurgery for Essential Tremor. Neurosurgery 2023; 93:524-538. [PMID: 37010324 PMCID: PMC10553193 DOI: 10.1227/neu.0000000000002462] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/26/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Focused ultrasound (FUS-T) and stereotactic radiosurgery thalamotomy (SRS-T) targeting the ventral intermediate nucleus are effective incisionless surgeries for essential tremor (ET). However, their efficacy for tremor reduction and, importantly, adverse event incidence have not been directly compared. OBJECTIVE To present a comprehensive systematic review with network meta-analysis examining both efficacy and adverse events (AEs) of FUS-T vs SRS-T for treating medically refractory ET. METHODS We conducted a systematic review and network meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the PubMed and Embase databases. We included all primary FUS-T/SRS-T studies with approximately 1-year follow-up, with unilateral Fahn-Tolosa-Marin Tremor Rating Scale or Clinical Rating Scale for Tremor scores prethalamotomy/post-thalamotomy and/or AEs. The primary efficacy outcome was Fahn-Tolosa-Marin Tremor Rating Scale A+B score reduction. AEs were reported as an estimated incidence. RESULTS Fifteen studies of 464 patients and 3 studies of 62 patients met inclusion criteria for FUS-T/SRS-T efficacy comparison, respectively. Network meta-analysis demonstrated similar tremor reduction between modalities (absolute tremor reduction: FUS-T: -11.6 (95% CI: -13.3, -9.9); SRS-T: -10.3 (95% CI: -14.2, -6.0). FUS-T had a greater 1-year adverse event rate, particularly imbalance and gait disturbances (10.5%) and sensory disturbances (8.3%). Contralateral hemiparesis (2.7%) often accompanied by speech impairment (2.4%) were most common after SRS-T. There was no correlation between efficacy and lesion volume. CONCLUSION Our systematic review found similar efficacy between FUS-T and SRS-T for ET, with trend toward higher efficacy yet greater adverse event incidence with FUS-T. Smaller lesion volumes could mitigate FUS-T off-target effects for greater safety.
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Affiliation(s)
- Sravani Kondapavulur
- Department of Neurological Surgery, UCSF, San Francisco, California, USA
- Medical Scientist Training Program, UCSF, San Francisco, California, USA
| | - Alexander B. Silva
- Department of Neurological Surgery, UCSF, San Francisco, California, USA
- Medical Scientist Training Program, UCSF, San Francisco, California, USA
| | | | - Doris D. Wang
- Department of Neurological Surgery, UCSF, San Francisco, California, USA
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11
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Zawadzki M, Pinkiewicz M, Pinkiewicz M, Walecki J, Walczak P, Gołubczyk D, Sady M, Gajewski Z. Real-Time MRI Monitoring of Liquid Embolic Agent (Onyx) Injection in a Swine Arteriovenous Malformation Model. Brain Sci 2023; 13:915. [PMID: 37371393 DOI: 10.3390/brainsci13060915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
The paradigm is gradually shifting, with radiosurgery and endovascular embolization being increasingly chosen over surgical resection in the selected cases of brain arteriovenous malformations. Routinely used X-ray monitoring of liquid embolic infusion has very good spatial and temporal resolution but is not without significant drawbacks regarding poor visualization of the complex AVM angioarchitecture, especially after many embolizations in the past and therefore limiting the technical ability of the embocure-total occlusion of the feeding arteries, nidus, and draining veins. The purpose of this study was to evaluate the use of real-time MRI guidance in endovascular embolization with Onyx (instead of X-ray) in a single swine rete mirabile (RM) AVM model in order to provide the scaffolding for the real-time MRI guidance method. Onyx propagation was observed in real-time dynamic GE-EPI scan with initial ipsilateral RM filling followed by main cerebral arterial branch distribution. The relatively bright signal within RM and the brain prior to Onyx injection provided a good background for the dark, low signal of the embolic agent spreading in rete mirabile and brain arteries. X-ray picture confirmed Onyx cast distribution at the end of the procedure. In this initial experience, real-time MRI seems to be a promising method that may significantly improve liquid embolic agent infusion monitoring in the future, although requiring further development before clinical use.
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Affiliation(s)
- Michał Zawadzki
- Department of Radiology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
- Division of Interventional Neuroradiology, Department of Radiology, The National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Miłosz Pinkiewicz
- Faculty of Medicine, Wroclaw Medical University, 50-368 Wrocław, Poland
| | - Mateusz Pinkiewicz
- Department of Diagnostic Imaging, Mazowiecki Regional Hospital in Siedlce, 08-110 Siedlce, Poland
| | - Jerzy Walecki
- Department of Radiology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland
- Division of Interventional Neuroradiology, Department of Radiology, The National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Piotr Walczak
- Program in Image Guided Neurointerventions, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Dominika Gołubczyk
- Center for Translational Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Maria Sady
- Center for Translational Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Zdzisław Gajewski
- Center for Translational Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
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12
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Gupta D, Choi D, Lu N, Allen SP, Hall TL, Noll DC, Xu Z. Magnetic Resonance Thermometry Targeting for Magnetic Resonance-Guided Histotripsy Treatments. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:1102-1107. [PMID: 36801181 PMCID: PMC10938365 DOI: 10.1016/j.ultrasmedbio.2022.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/08/2022] [Accepted: 12/16/2022] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The potential of transcranial magnetic resonance (MR)-guided histotripsy for brain applications has been described in prior in vivo studies in the swine brain through an excised human skull. The safety and accuracy of transcranial MR-guided histotripsy (tcMRgHt) rely on pre-treatment targeting guidance. In the work described here, we investigated the feasibility and accuracy of using ultrasound-induced low-temperature heating and MR thermometry for histotripsy pre-treatment targeting in ex vivo bovine brain. METHODS A 15-element, 750-kHz MRI-compatible ultrasound transducer with modified drivers that can deliver both low-temperature heating and histotripsy acoustic pulses was used to treat seven bovine brain samples. The samples were first heated to an approximately 1.6°C temperature increase at the focus, and MR thermometry was used to localize the target. Once the targeting was confirmed, a histotripsy lesion was generated at the focus and visualized on post-histotripsy MR images. DISCUSSION The accuracy of MR thermometry targeting was evaluated with the mean/standard deviation of the difference between the locus of peak heating identified by MR thermometry and the center of mass of the post-treatment histotripsy lesion, which was 0.59/0.31 mm and 1.31/0.93 mm in the transverse and longitudinal directions, respectively. CONCLUSION This study determined that MR thermometry could provide reliable pre-treatment targeting for transcranial MR-guided histotripsy treatment.
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Affiliation(s)
- Dinank Gupta
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Dave Choi
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ning Lu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Steven P Allen
- Department of Electrical and Computer Engineering, Brigham Young University, Provo, UT, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Douglas C Noll
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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13
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Yamamoto K, Sarica C, Loh A, Vetkas A, Samuel N, Milano V, Zemmar A, Germann J, Cheyuo C, Boutet A, Elias GJ, Ito H, Taira T, Lozano AM. Magnetic resonance-guided focused ultrasound for the treatment of tremor. Expert Rev Neurother 2022; 22:849-861. [PMID: 36469578 DOI: 10.1080/14737175.2022.2147826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging treatment for tremor and other movement disorders. An incisionless therapy, it is becoming increasingly common worldwide. However, given MRgFUS' relative novelty, there remain limited data on its benefits and adverse effects. AREAS COVERED We review the current state of evidence of MRgFUS for tremor, highlight its challenges, and discuss future perspectives. EXPERT OPINION Essential tremor (ET) has been the major indication for MRgFUS since a milestone randomized controlled trial (RCT) in 2016, with substantial evidence attesting to the efficacy and acceptable safety profile of this treatment. Patients with other tremor etiologies are also being treated with MRgFUS, with studies - including an RCT - suggesting parkinsonian tremor in particular responds well to this intervention. Additionally, targets other than the ventral intermediate nucleus, such as the subthalamic nucleus and internal segment of the globus pallidus, have been reported to improve parkinsonian symptoms beyond tremor, including rigidity and bradykinesia. Although MRgFUS is encumbered by certain unique technical challenges, it nevertheless offers significant advantages compared to alternative neurosurgical interventions for tremor. The fast-growing interest in this treatment modality will likely lead to further scientific and technological advancements that could optimize and expand its therapeutic potential.
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Affiliation(s)
- Kazuaki Yamamoto
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Can Sarica
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Department of Neurosurgery, School of Medicine, University of Tartu, Estonia
| | - Nardin Samuel
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Vanessa Milano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Ajmal Zemmar
- Department of Neurosurgery, University of Louisville, School of Medicine, KY, USA.,Department of Neurosurgery, Henan University People's Hospital, Henan University School of Medicine, China
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Cletus Cheyuo
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Gavin Jb Elias
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada
| | - Hisashi Ito
- Department of Neurology, Shonantobu General Hospital, Japan.,Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
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14
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Update in the clinical application of focused ultrasound. Curr Opin Neurol 2022; 35:525-535. [PMID: 35788096 DOI: 10.1097/wco.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review the most recent evidence about the clinical applicability of transcranial MRI-guided focused ultrasound (MRgFUS), including clinical evidence and indications, recent technical developments for its use and future prospects. RECENT FINDINGS Unilateral MRgFUS thalamotomy for both essential and parkinsonian tremors is an approved and well established therapy. Recent studies have focused on its long-term safety and efficacy as well as technical advances for refining the approach. Moreover, ultrasound has expanded its application in Parkinson's disease, with clinical trials successfully targeting other brain regions like the subthalamic nucleus, the globus pallidus and the pallidothalamic tract, providing benefits for features that thalamotomy neglects. New indications, such as focal dystonia or neuropsychiatric conditions (namely obsessive-compulsive disorder and depression) have also been explored, with encouraging preliminary results. Finally, the application of ultrasound in low-intensity modality allows other approaches like focal blood-brain barrier opening and neuromodulation, which promise to be highly relevant in translational research. SUMMARY MRgFUS is a growing emergent technique. Its application in clinical routine is becoming widely accepted as a therapeutic option. Novel approaches and new potential applications are anticipated.
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15
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Shetty N. Essential Tremor-Do We Have Better Therapeutics? A Review of Recent Advances and Future Directions. Curr Neurol Neurosci Rep 2022; 22:197-208. [PMID: 35235170 DOI: 10.1007/s11910-022-01185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Essential tremor (ET) is a very common condition that significantly impacts quality of life. Current medical treatments are quite limited, and while surgical treatments like deep brain stimulation (DBS) can be very effective, they come with their own limitations as well as procedural risks. This article reviews updates on recent advances and future directions in the treatment of ET. RECENT FINDINGS A new generation of pharmacologic agents specifically designed for ET is in clinical trials. Advances in DBS technology continue to improve this therapy. MRI-guided focused ultrasound (MRgFUS) is now an approved noninvasive ablative treatment for ET that is effective and shows potential for continuing improvement. The first peripheral stimulation device for ET has also now been approved. This article reviews updates on the treatment of ET, encompassing pharmacologic agents in clinical trials, DBS, MRgFUS, and noninvasive stimulation therapies. Recent treatment advances and future directions of development show a great deal of promise for ET therapeutics.
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Affiliation(s)
- Neil Shetty
- Parkinson's Disease and Movement Disorders Center, Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall, 11th Floor, 710 N. Lake Shore Drive, Chicago, IL, 60611, USA.
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16
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Sinai A, Nassar M, Sprecher E, Constantinescu M, Zaaroor M, Schlesinger I. Focused Ultrasound Thalamotomy in Tremor Dominant Parkinson's Disease: Long-Term Results. JOURNAL OF PARKINSONS DISEASE 2021; 12:199-206. [PMID: 34602500 PMCID: PMC8842770 DOI: 10.3233/jpd-212810] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: MRI-guided focused ultrasound (FUS) has established short-term efficacy in tremor relief. Objective: We report our long-term experience of treating tremor with unilateral FUS unilateral VIM-thalamotomy in tremor dominant Parkinson’s disease (TDPD) patients. Methods: We report outcome of FUS thalamotomy in TDPD patients with 1–5 years of follow-up. Outcomes: tremor reduction assessed with Clinical Rating Scale for Tremor (CRST) and Unified Parkinson’s Disease Rating Scale (UPDRS part III) overall and in the treated hemibody and safety. Results: Twenty-six TDPD patients completed 1–5 years of follow-up (median follow-up 36 months, range 12–60 months). Median age was 60 years (range 46–79), with median disease duration of 6 years (range 2–16). Immediately, treatment resulted in 100%improvement in tremor in the treated arm in 23 patients and 90%improvement in 3 patients. In 15 patients with leg tremor, 2 patients with chin tremor and 1 patient with head tremor, tremor was significantly improved. Up to 5 years, median CRST score, median UPDRS score, overall and in treated hemibody, decreased significantly as compared with baseline (p < 0.0001). In 2 patients tremor returned completely and in 8 patients there was partial return of tremor. Adverse events were mild and resolved within 3 months. At baseline 4 patients were not receiving any medication vs. 3 at last follow-up and 15 were not taking levodopa vs.9 at last follow-up. Conclusion: Unilateral FUS VIM-thalamotomy in TDPD patients was effective and safe and provided long-term tremor relief in most patients. FUS thalamotomy for tremor may delay initiation of levodopa treatment.
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Affiliation(s)
- Alon Sinai
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
| | - Maria Nassar
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | - Elliot Sprecher
- Movement Disorders Institute, Department of Neurology, Rambam Health Care Campus, Haifa, Israel
| | | | - Menashe Zaaroor
- Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel
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