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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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Hashida M, Maesawa S, Kato S, Nakatsubo D, Tsugawa T, Torii J, Tanei T, Ishizaki T, Mutoh M, Ito Y, Tsuboi T, Mizuno S, Suzuki M, Wakabayashi T, Katsuno M, Saito R. Outcomes and Prognostic Factors of Magnetic Resonance-guided Focused Ultrasound Thalamotomy for Essential Tremor at 2-year Follow-up. Neurol Med Chir (Tokyo) 2024; 64:137-146. [PMID: 38355128 PMCID: PMC11099165 DOI: 10.2176/jns-nmc.2023-0202] [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: 08/27/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an effective treatment for essential tremor (ET). However, its long-term outcomes and prognostic factors remain unclear. This study aimed to retrospectively investigate 38 patients with ET who underwent MRgFUS thalamotomy and were followed up for >2 years. The improvement in tremor was evaluated using the Clinical Rating Scale for Tremor (CRST). Adverse events were documented, and correlations with factors, such as skull density ratio (SDR), maximum mean temperature (T-max), and lesion size, were examined. Furthermore, the outcomes were compared between two groups, one that met the cutoff values, which was previously reported (preoperative CRST-B ≤ 25, T-max ≥ 52.5°C, anterior-posterior size of lesion ≥ 3.9 mm, superior-inferior [SI] size of lesion > 5.5 mm), and the other that did not. The improvement rate was 59.4% on average at the 2-year follow-up. Adverse events, such as numbness (15.8%), dysarthria (10.5%), and lower extremity weakness (2.6%), were observed even after 2 years, although these were mild. The factors correlated with tremor improvement were the T-max and SI size of the lesion (p < 0.05), whereas the SDR showed no significance. Patients who met the aforementioned cutoff values demonstrated a 69.8% improvement at the 2-year follow-up, whereas others showed a 43.6% improvement (p < 0.05). In conclusion, MRgFUS is effective even after 2 years. The higher the T-max and the larger the lesion size, the better the tremor control. Previously reported cutoff values clearly predict the 2-year prognosis, indicating the usefulness of MRgFUS.
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Affiliation(s)
- Miki Hashida
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Brain and Mind Research Center, Nagoya University
| | - Sachiko Kato
- Focused Ultrasound Surgery Center, Nagoya Kyoritsu Hospital
| | | | | | - Jun Torii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Tomotaka Ishizaki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Manabu Mutoh
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Yoshiki Ito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
| | - Takashi Tsuboi
- Department of Neurology, Nagoya University Graduate School of Medicine
| | - Satomi Mizuno
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center
| | - Masashi Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine
- Department of Clinical Laboratory, Nagoya University Hospital
| | | | - Masahisa Katsuno
- Brain and Mind Research Center, Nagoya University
- Department of Neurology, Nagoya University Graduate School of Medicine
- Department of Clinical Research Education, Nagoya University Graduate School of Medicine
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine
- Brain and Mind Research Center, Nagoya University
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Eleni Karakatsani M, Estrada H, Chen Z, Shoham S, Deán-Ben XL, Razansky D. Shedding light on ultrasound in action: Optical and optoacoustic monitoring of ultrasound brain interventions. Adv Drug Deliv Rev 2024; 205:115177. [PMID: 38184194 PMCID: PMC11298795 DOI: 10.1016/j.addr.2023.115177] [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: 10/09/2023] [Revised: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
Monitoring brain responses to ultrasonic interventions is becoming an important pillar of a growing number of applications employing acoustic waves to actuate and cure the brain. Optical interrogation of living tissues provides a unique means for retrieving functional and molecular information related to brain activity and disease-specific biomarkers. The hybrid optoacoustic imaging methods have further enabled deep-tissue imaging with optical contrast at high spatial and temporal resolution. The marriage between light and sound thus brings together the highly complementary advantages of both modalities toward high precision interrogation, stimulation, and therapy of the brain with strong impact in the fields of ultrasound neuromodulation, gene and drug delivery, or noninvasive treatments of neurological and neurodegenerative disorders. In this review, we elaborate on current advances in optical and optoacoustic monitoring of ultrasound interventions. We describe the main principles and mechanisms underlying each method before diving into the corresponding biomedical applications. We identify areas of improvement as well as promising approaches with clinical translation potential.
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Affiliation(s)
- Maria Eleni Karakatsani
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Héctor Estrada
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Zhenyue Chen
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Shy Shoham
- Department of Ophthalmology and Tech4Health and Neuroscience Institutes, NYU Langone Health, NY, USA
| | - Xosé Luís Deán-Ben
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland.
| | - Daniel Razansky
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland.
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Jamora RDG, Khu KJO, Sy MCC, Pascual JSG, Legaspi GD, Aguilar JA. Transcranial magnetic resonance-guided focused ultrasound pallidothalamic tractotomy for patients with X-linked dystonia-parkinsonism: a study protocol. BMC Neurol 2023; 23:306. [PMID: 37596524 PMCID: PMC10436542 DOI: 10.1186/s12883-023-03344-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 07/25/2023] [Indexed: 08/20/2023] Open
Abstract
Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) is a noninvasive method for controlling tremor and has recently been used in patients with X-linked dystonia-parkinsonism (XDP). This study aims to determine the improvement in dystonia and parkinsonism in patients with XDP after MRgFUS pallidothalamic tractotomy. This prospective study will be conducted at the Philippine General Hospital, University of the Philippines Manila. The primary outcome measure is the change in the pre- and post-treatment XDP-Movement Disorder Society of the Philippines Scale scores. In addition, demographic and clinical data will be collected, including the Burke-Fahn-Marsden Dystonia Rating Scale, Part III of the Movement Disorder Society-Unified Parkinson's disease Rating Scale score, XDP clinical and functional stage, the five-level EuroQol five-dimensional questionnaire, Montreal Cognitive Assessment scores, MRgFUS treatment parameters, and adverse events. Patients will be assessed within 24 hours of treatment, then at 2 weeks, 3 months, 6 months, 9 months, and 12 months post-treatment. This protocol was approved by the University of the Philippines Manila Research Ethics Board (UPMREB 2022-0271-01). Data collection began in January 2023. This protocol has been registered with ClinicalTrials.gov: Trial Registration number: NCT05592028.
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Affiliation(s)
- Roland Dominic G Jamora
- Division of Adult Neurology, Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Marie Charmaine C Sy
- Division of Adult Neurology, Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Juan Silvestre G Pascual
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jose A Aguilar
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Kato S, Maesawa S, Bagarinao E, Nakatsubo D, Tsugawa T, Mizuno S, Kawabata K, Tsuboi T, Suzuki M, Shibata M, Takai S, Ishizaki T, Torii J, Mutoh M, Saito R, Wakabayashi T, Katsuno M, Ozaki N, Watanabe H, Sobue G. Magnetic resonance-guided focused ultrasound thalamotomy restored distinctive resting-state networks in patients with essential tremor. J Neurosurg 2023; 138:306-317. [PMID: 35901706 DOI: 10.3171/2022.5.jns22411] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy ameliorates symptoms in patients with essential tremor (ET). How this treatment affects canonical brain networks has not been elucidated. The purpose of this study was to clarify changes of brain networks after MRgFUS thalamotomy in ET patients by analyzing resting-state networks (RSNs). METHODS Fifteen patients with ET were included in this study. Left MRgFUS thalamotomy was performed in all cases, and MR images, including resting-state functional MRI (rsfMRI), were taken before and after surgery. MR images of 15 age- and sex-matched healthy controls (HCs) were also used for analysis. Using rsfMRI data, canonical RSNs were extracted by performing dual regression analysis, and the functional connectivity (FC) within respective networks was compared among pre-MRgFUS patients, post-MRgFUS patients, and HCs. The severity of tremor was evaluated using the Clinical Rating Scale for Tremor (CRST) score pre- and postoperatively, and its correlation with RSNs was examined. RESULTS Preoperatively, ET patients showed a significant decrease in FC in the sensorimotor network (SMN), primary visual network (VN), and visuospatial network (VSN) compared with HCs. The decrease in FC in the SMN correlated with the severity of tremor. After MRgFUS thalamotomy, ET patients still exhibited a significant decrease in FC in a small area of the SMN, but they exhibited an increase in the cerebellar network (CN). In comparison between pre- and post-MRgFUS patients, the FC in the SMN and the VSN significantly increased after treatment. Quantitative evaluation of the FCs in these three groups showed that the SMN and VSN increased postoperatively and demonstrated a trend toward those of HCs. CONCLUSIONS The SMN and CN, which are considered to be associated with the cerebello-thalamo-cortical loop, exhibited increased connectivity after MRgFUS thalamotomy. In addition, the FC of the visual network, which declined in ET patients compared with HCs, tended to normalize postoperatively. This could be related to the hypothesis that visual feedback is involved in tremor severity in ET patients. Overall, the analysis of the RSNs by rsfMRI reflected the pathophysiology with the intervention of MRgFUS thalamotomy in ET patients and demonstrated a possibility of a biomarker for successful treatment.
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Affiliation(s)
- Sachiko Kato
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya.,2Focused Ultrasound Therapy Center, Nagoya Kyoritsu Hospital, Nakagawa, Nagoya
| | - Satoshi Maesawa
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya.,3Brain and Mind Research Center, Nagoya University, Showa, Nagoya
| | | | - Daisuke Nakatsubo
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya.,2Focused Ultrasound Therapy Center, Nagoya Kyoritsu Hospital, Nakagawa, Nagoya
| | - Takahiko Tsugawa
- 2Focused Ultrasound Therapy Center, Nagoya Kyoritsu Hospital, Nakagawa, Nagoya
| | - Satomi Mizuno
- 4Department of Rehabilitation, National Hospital Organization, Nagoya Medical Center, Naka, Nagoya
| | - Kazuya Kawabata
- 5Department of Neurology, Nagoya University Graduate School of Medicine, Showa, Nagoya
| | - Takashi Tsuboi
- 5Department of Neurology, Nagoya University Graduate School of Medicine, Showa, Nagoya
| | - Masashi Suzuki
- 5Department of Neurology, Nagoya University Graduate School of Medicine, Showa, Nagoya
| | - Masashi Shibata
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Sou Takai
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Tomotaka Ishizaki
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Jun Torii
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Manabu Mutoh
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya
| | - Ryuta Saito
- 1Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya
| | | | - Masahisa Katsuno
- 5Department of Neurology, Nagoya University Graduate School of Medicine, Showa, Nagoya
| | - Norio Ozaki
- 3Brain and Mind Research Center, Nagoya University, Showa, Nagoya.,6Department of Psychiatry, Nagoya University Graduate School of Medicine, Showa, Nagoya; and
| | - Hirohisa Watanabe
- 3Brain and Mind Research Center, Nagoya University, Showa, Nagoya.,7Department of Neurology, Fujita Medical University, Kutsukake, Toyoake; and
| | - Gen Sobue
- 3Brain and Mind Research Center, Nagoya University, Showa, Nagoya.,8Aichi Medical University, Karimata, Nagakute, Aichi, Japan
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6
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Rawls AE. Surgical Therapies for Parkinson Disease. Continuum (Minneap Minn) 2022; 28:1301-1313. [DOI: 10.1212/con.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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