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Larcipretti ALL, Gomes FC, Udoma-Udofa OC, Jannotti JBN, Bannach MDA. Radiosurgical thalamotomy for the management of tremors: a systematic review and meta-analysis. Neurol Sci 2024:10.1007/s10072-024-07670-x. [PMID: 38967882 DOI: 10.1007/s10072-024-07670-x] [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: 06/06/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024]
Abstract
Medical treatment for tremors may include beta-blockers, primidone, dopaminergic, and anticholinergic drugs but it frequently leads to pharmacoresistance. Therefore, surgical treatment gained relevance as an alternative for those patients.We aim to evaluate radiosurgical thalamotomy as an effective and safe alternative to manage tremors. Pubmed (MEDLINE), Embase, Web of Science, and the Cochrane Library databases were systematically searched for potential articles that evaluated radiosurgical thalamotomy for the management of tremor. Our analysis included 12 studies with 545 patients, 226 of whom were female. Of these, 64.6% of patients were diagnosed with essential tremor (ET), 34.6% with Parkinson's disease (PD), and 0.8% with both ET and PD. The FTM-TRS global score (MD -5.46; 95% CI [-10.44]-[-0.47]; I2 = 52%) and the drawing (MD -1.40; 95% CI [-2.03]-[-0.76]; I2 = 93%), drinking (MD -1.60; 95% CI [-1.82]-[-1.37]; I2 = 40%), and writing (MD -1.51; 95% CI [-1.89]-[-1.13]; I2 = 89%) grades showed significantly lower mean differences, favoring radiosurgical thalamotomy. A pooled proportion of 12% presented with tremor unchanged, while 38% presented with total elimination of tremor. Adverse events included: major paresis, minor paresis, dysarthria, and numbness. Thus, radiosurgical thalamotomy is a safe alternative for tremors resistant to medication, particularly in high-risk patients for RF or DBS procedures. The recommended dose of 130 to 150 Gy is effective and well-tolerated. However, randomized controlled trials (RCTs) are needed to understand the unpredictability of tissue response to radiation.
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Affiliation(s)
| | | | | | | | - Matheus de Andrade Bannach
- Department of Surgery, Neurology and Neurosurgery Unit, Federal University of Góias, Goiânia, 74690-900, Brazil.
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Bilski M, Szklener K, Szklener S, Rudzińska A, Kluz N, Klas J, Rodzajewska A, Kuryło W, Korga M, Baranowska I, Mańdziuk S. Stereotactic radiosurgery in the treatment of essential tremor - a systematic review. Front Neurol 2024; 15:1370091. [PMID: 38633530 PMCID: PMC11021759 DOI: 10.3389/fneur.2024.1370091] [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: 01/13/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Essential tremor (ET) is the most common movement disorder in adults, with an estimated incidence of up to 1% of the population and 5% of people older than 65 years of age. ET is manifested primarily by bilateral postural and kinetic tremor of the upper limbs with or without neurological symptoms and cognitive deficits. ET disrupts daily tasks and significantly lowers quality of life. Currently available medications alone are often insufficient to control severe symptoms. Several surgical treatment options are available, including stereotactic radiosurgery (SRS)-a minimally invasive treatment option aimed at relieving and controlling tremors. Methods We conducted a systematic review of the scientific literature on the use of SRS in the treatment of ET using PubMed, Scopus, Web of Science, Cochrane, ScienceDirect, and ClinicalTrials.gov registry and adhered to the PRISMA guidelines. Results The results obtained confirm the high efficacy and safety of the SRS procedure in treating drug-resistant intention tremor. The study results present high response rate reaching 80% and achievement of manual task improvement, lessening of the tremor and increase in the quality of life of the majority of the operated patients. The method also stands out for its favorable balance between efficiency and cost. Disscusion Stereotactic radiosurgery is a favourable, safe, efficient and cost-effective method in treatment of the essential tremor. Ongoing research is crucial to refine patient selection criteria for this procedure and further improve the effectiveness of the technique.
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Affiliation(s)
- Mateusz Bilski
- Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
- Brachytherapy Department, Saint John’s Cancer Center, Lublin, Poland
- Radiotherapy Department, Saint John’s Cancer Center, Lublin, Poland
| | - Katarzyna Szklener
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
| | | | - Anna Rudzińska
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
| | - Natalia Kluz
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Jakub Klas
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Anna Rodzajewska
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Weronika Kuryło
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Mateusz Korga
- Student Scientific Circle at the Department of Radiotherapy, Medical University of Lublin, Lublin, Poland
| | - Izabela Baranowska
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
- Department of Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Sławomir Mańdziuk
- Department of Clinical Oncology and Chemotherapy, Medical University of Lublin, Lublin, Poland
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Marianayagam NJ, Paddick I, Persad AR, Hori YS, Maslowski A, Thirunarayanan I, Khanna AR, Park DJ, Buch V, Chang SD, Schneider MB, Yu H, Weidlich GA, Adler JR. Dosimetric Comparison of Dedicated Radiosurgery Platforms for the Treatment of Essential Tremor: Technical Report. Cureus 2024; 16:e57452. [PMID: 38699125 PMCID: PMC11064878 DOI: 10.7759/cureus.57452] [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: 02/12/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Essential tremor (ET) is one of the most common adult movement disorders. As the worldwide population ages, the incidence and prevalence of ET is increasing. Although most cases can be managed conservatively, there is a subset of ET that is refractory to medical management. By virtue of being "reversible", deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus is one commonly accepted intervention. As an alternative to invasive and expensive DBS, there has been a renaissance in treating ET with lesion-based approaches, spearheaded most recently by high-intensity focused ultrasound (HIFU), the hallmark of which is that it is non-invasive. Meanwhile, stereotactic radiosurgical (SRS) lesioning of VIM represents another time-honored lesion-based non-invasive treatment of ET, which is especially well suited for those patients that cannot tolerate open neurosurgery and is now also getting a "second look". While multiple SRS platforms have been and continue to be used to treat ET, there is little in the way of dosimetric comparison between different technologies. In this brief technical report we compare the dosimetric profiles of three major radiosurgical platforms (Gamma Knife, CyberKnife Robotic Radiosurgery, and Zap-X Gyroscopic Radiosurgery (GRS)) for the treatment of ET. In general, the GRS and Gamma Knife were shown to have the best theoretical dosimetric profiles for VIM lesioning. Nevertheless the relevance of such superiority to clinical outcomes requires future patient studies.
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Affiliation(s)
| | - Ian Paddick
- National Centre for Neurology and Neurosurgery, Queen Square Radiosurgery Centre, London, GBR
| | - Amit R Persad
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Yusuke S Hori
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | | | | | - Arjun R Khanna
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - David J Park
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - Vivek Buch
- Neurological Surgery, Stanford University Medical Center, Palo Alto, USA
| | - Steven D Chang
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
| | - M Bret Schneider
- Stereotactic Radiosurgery, Zap Surgical Systems, Inc., San Carlos, USA
- Psychiatry, Stanford University School of Medicine, Stanford, USA
| | - Hong Yu
- Neurological Surgery, Vanderbilt University, Nashville, USA
| | | | - John R Adler
- Radiation Oncology, Stanford University Medical Center, Palo Alto, USA
- Neurosurgery, Stanford University School of Medicine, Stanford, USA
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Dynamic functional changes upon thalamotomy in essential tremor depend on baseline brain morphometry. Sci Rep 2024; 14:2605. [PMID: 38297028 PMCID: PMC10831051 DOI: 10.1038/s41598-024-52410-y] [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: 03/16/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
Patients with drug-resistant essential tremor (ET) may undergo Gamma Knife stereotactic radiosurgical thalamotomy (SRS-T), where the ventro-intermediate nucleus of the thalamus (Vim) is lesioned by focused beams of gamma radiations to induce clinical improvement. Here, we studied SRS-T impacts on left Vim dynamic functional connectivity (dFC, n = 23 ET patients scanned before and 1 year after intervention), and on surface-based morphometric brain features (n = 34 patients, including those from dFC analysis). In matched healthy controls (HCs), three dFC states were extracted from resting-state functional MRI data. In ET patients, state 1 spatial stability increased upon SRS-T (F1,22 = 19.13, p = 0.004). More frequent expression of state 3 over state 1 before SRS-T correlated with greater clinical recovery in a way that depended on the MR signature volume (t6 = 4.6, p = 0.004). Lower pre-intervention spatial variability in state 3 expression also did (t6 = - 4.24, p = 0.005) and interacted with the presence of familial ET so that these patients improved less (t6 = 4.14, p = 0.006). ET morphometric profiles showed significantly lower similarity to HCs in 13 regions upon SRS-T (z ≤ - 3.66, p ≤ 0.022), and a joint analysis revealed that before thalamotomy, morphometric similarity and states 2/3 mean spatial similarity to HCs were anticorrelated, a relationship that disappeared upon SRS-T (z ≥ 4.39, p < 0.001). Our results show that left Vim functional dynamics directly relates to upper limb tremor lowering upon intervention, while morphometry instead has a supporting role in reshaping such dynamics.
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Affiliation(s)
- Thomas A W Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland.
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), 1011, Lausanne, Switzerland.
| | - Dimitri Van De Ville
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, 1202, Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), 1015, Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), 1015, Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland
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5
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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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Lipsman N, McDonald PJ, Illes J. Perceptions of Invasiveness: A Moving Target for Neuromodulation. AJOB Neurosci 2023; 14:15-17. [PMID: 36524950 DOI: 10.1080/21507740.2022.2150709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Gunawan K, Santoso F, Aman RA, Tandian D, Nugroho SW. Gamma Knife Radiosurgery for Tremor Movement Disorder: A Systematic Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.10965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM: The goal of this systematic review is to know how outcome of GKRS for tremor movement disorder.
METHODS: Literature searching was conducted in database online that is PubMed, Science Direct, Cochrane Library, Google Scholar and hand searching with keyword “gamma knife,” “parkinson,” “tremor,” “success rate,” “good outcome,” and “free tremor.” Articles included were full-text and observational study and written in Bahasa or English.
RESULTS: This systematic review used only six articles, which five of them examined ET and the other PD. Majority of studies used Fahn-Tolosa-Marin clinical tremor rating scale (TRS) for evaluation pre- and post-GKRS. However, the duration of follow-up is varies from <1 year until 76 months. The doses are also varies from 110 until 150 Gy (Median 120–130 Gy). A study report that 1 year after GKRS, ET patients could have 58% improvement in writing and 51% in drawing. Other study, which of median follow-up was 36 months, had 69% of samples showed improvement in both action tremor and writing scores. Ohye et al. in 2008 reported that since 1992, they have 80% successful in GK thalamotomy for tremor, either ET or PD. Similar author has been done multivariate study in six Japanese institution which of result was GKRS thalamotomy could be alternative treatment for intractable tremor, either ET or PD until 24 months. All of the study about ET have improvement results with GKRS in ventralis intermedius (VIM) of the thalamus. However, one study about PD evaluated GKRS in subthalamic nucleus (STN) of thalamus and got neurological complication with higher-risk of GKRS hyper response.
CONCLUSION: GKRS, especially VIM thalamotomy, offers effective and safe alternative for ET and PD. We need more studies with approved method to answer this clinical question accurately. However, the study comparing GKRS and open surgical is still needed.
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Parras O, Domínguez P, Tomás-Biosca A, Guridi J. The role of tractography in the localization of the Vim nucleus of the thalamus and the dentato-rubro-thalamic tract for the treatment of tremor. Neurologia 2022; 37:691-699. [PMID: 31917004 DOI: 10.1016/j.nrl.2019.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/08/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The ventralis intermedius (Vim) nucleus of the thalamus is the usual surgical target for tremor. However, locating the structure may be difficult as it is not visible with conventional imaging methods; therefore, surgical procedures typically use indirect calculations correlated with clinical and intraoperative neurophysiological findings. Current ablative surgical procedures such as Gamma-Knife thalamotomy and magnetic resonance-guided focused ultrasound require new alternatives for locating the Vim nucleus. In this review, we compare Vim nucleus location for the treatment of tremor using stereotactic procedures versus direct location by means of tractography. DISCUSSION The most widely used cytoarchitectonic definition of the Vim nucleus is that established by Schaltenbrand and Wahren. There is a well-defined limit between the motor and the sensory thalamus; Vim neurons respond to passive joint movements and are synchronous with peripheral tremor. The most frequently used stereotactic coordinates for the Vim nucleus are based on indirect calculations referencing the mid-commissural line and third ventricle, which vary between patients. Recent studies suggest that the dentato-rubro-thalamic tract is an optimal target for controlling tremor, citing a clinical improvement; however, this has not yet been corroborated. CONCLUSIONS Visualisation of the cerebello-rubro-thalamic pathway by tractography may help in locating the Vim nucleus. The technique has several limitations, and the method requires standardisation to obtain more precise results. The utility of direct targeting by tractography over indirect targeting for patients with tremor remains to be demonstrated in the long-term.
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Affiliation(s)
- O Parras
- Servicio de Neurocirugía, Clínica Universidad de Navarra, Pamplona, España
| | - P Domínguez
- Servicio de Neurorradiología, Clínica Universidad de Navarra, Pamplona, España
| | - A Tomás-Biosca
- Servicio de Neurocirugía, Clínica Universidad de Navarra, Pamplona, España
| | - J Guridi
- Servicio de Neurocirugía, Clínica Universidad de Navarra, Pamplona, España.
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Jung IH, Chang KW, Park SH, Jung HH, Chang JH, Chang JW, Chang WS. Pseudoprogression and peritumoral edema due to intratumoral necrosis after Gamma knife radiosurgery for meningioma. Sci Rep 2022; 12:13663. [PMID: 35953695 PMCID: PMC9372131 DOI: 10.1038/s41598-022-17813-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Peritumoral cerebral edema is reported to be a side effect that can occur after stereotactic radiosurgery. We aimed to determine whether intratumoral necrosis (ITN) is a risk factor for peritumoral edema (PTE) when gamma knife radiosurgery (GKRS) is performed in patients with meningioma. In addition, we propose the concept of pseudoprogression: a temporary volume expansion that can occur after GKRS in the natural course of meningioma with ITN. This retrospective study included 127 patients who underwent GKRS for convexity meningioma between January 2019 and December 2020. Risk factors for PTE and ITN were investigated using logistic regression analysis. Analysis of variance was used to determine whether changes in tumor volume were statistically significant. After GKRS, ITN was observed in 34 (26.8%) patients, and PTE was observed in 10 (7.9%) patients. When postoperative ITN occurred after GKRS, the incidence of postoperative PTE was 18.970-fold (p = 0.009) greater. When a 70% dose volume ≥ 1 cc was used, the possibility of ITN was 5.892-fold (p < 0.001) higher. On average, meningiomas with ITN increased in volume by 128.5% at 6 months after GKRS and then decreased to 94.6% at 12 months. When performing GKRS in meningioma, a 70% dose volume ≥ 1 cc is a risk factor for ITN. At 6 months after GKRS, meningiomas with ITN may experience a transient volume expansion and PTE, which are characteristics of pseudoprogression. These characteristics typically improve at 12 months following GKRS.
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Affiliation(s)
- In-Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.,Department of Neurosurgery, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
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Luo G, Cameron BD, Wang L, Yu H, Neimat JS, Hedera P, Phibbs F, Bradley EB, Cmelak AJ, Kirschner AN. Targeting for stereotactic radiosurgical thalamotomy based on tremor treatment response. J Neurosurg 2022; 136:1387-1394. [PMID: 34715657 DOI: 10.3171/2021.7.jns21160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Stereotactic radiosurgery (SRS) treats severe, medically refractory essential tremor and tremor-dominant Parkinson disease. However, the optimal target for SRS treatment within the thalamic ventral intermediate nucleus (VIM) is not clearly defined. This work evaluates the precision of the physician-selected VIM target, and determines the optimal SRS target within the VIM by correlation between early responders and nonresponders. METHODS Early responders and nonresponders were assessed retrospectively by Elements Basal Ganglia Atlas autocontouring of the VIM on the pre-SRS-treatment 1-mm slice thickness T1-weighted MRI and correlating the center of the post-SRS-treatment lesion. Using pre- and posttreatment diffusion tensor imaging, the fiber tracking package in the Elements software generated tremor-related tracts from autosegmented motor cortex, thalamus, red nucleus, and dentate nucleus. Autocontouring of the VIM was successful for all patients. RESULTS Among 23 patients, physician-directed SRS targets had a medial-lateral target range from +2.5 mm to -2.0 mm from the VIM center. Relative to the VIM center, the SRS isocenter target was 0.7-0.9 mm lateral for 6 early responders and 0.9-1.1 mm medial for 4 nonresponders (p = 0.019), and without differences in the other dimensions: 0.2 mm posterior and 0.6 mm superior. Dose-volume histogram analyses for the VIM had no significant differences between responders and nonresponders between 20 Gy and 140 Gy, mean or maximum dose, and dose to small volumes. Tractography data was obtained for 4 patients. CONCLUSIONS For tremor control in early responders, the Elements Basal Ganglia Atlas autocontour for the VIM provides the optimal SRS target location that is 0.7-0.9 mm lateral to the VIM center.
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Affiliation(s)
| | | | | | - Hong Yu
- 3Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph S Neimat
- 4Department of Neurological Surgery, University of Louisville, Kentucky; and
| | - Peter Hedera
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fenna Phibbs
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elise B Bradley
- 5Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
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Binder DK, Shah BB, Elias WJ. Focused ultrasound and other lesioning in the treatment of tremor. J Neurol Sci 2022; 435:120193. [DOI: 10.1016/j.jns.2022.120193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
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12
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Parras O, Domínguez P, Tomás-Biosca A, Guridi J. The role of tractography in the localisation of the Vim nucleus of the thalamus and the dentatorubrothalamic tract for the treatment of tremor. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:691-699. [DOI: 10.1016/j.nrleng.2019.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022] Open
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Kremer NI, Pauwels RWJ, Pozzi NG, Lange F, Roothans J, Volkmann J, Reich MM. Deep Brain Stimulation for Tremor: Update on Long-Term Outcomes, Target Considerations and Future Directions. J Clin Med 2021; 10:3468. [PMID: 34441763 PMCID: PMC8397098 DOI: 10.3390/jcm10163468] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 01/11/2023] Open
Abstract
Deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus is one of the main advanced neurosurgical treatments for drug-resistant tremor. However, not every patient may be eligible for this procedure. Nowadays, various other functional neurosurgical procedures are available. In particular cases, radiofrequency thalamotomy, focused ultrasound and radiosurgery are proven alternatives to DBS. Besides, other DBS targets, such as the posterior subthalamic area (PSA) or the dentato-rubro-thalamic tract (DRT), may be appraised as well. In this review, the clinical characteristics and pathophysiology of tremor syndromes, as well as long-term outcomes of DBS in different targets, will be summarized. The effectiveness and safety of lesioning procedures will be discussed, and an evidence-based clinical treatment approach for patients with drug-resistant tremor will be presented. Lastly, the future directions in the treatment of severe tremor syndromes will be elaborated.
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Affiliation(s)
- Naomi I. Kremer
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.I.K.); (R.W.J.P.)
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Rik W. J. Pauwels
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (N.I.K.); (R.W.J.P.)
| | - Nicolò G. Pozzi
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Florian Lange
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Jonas Roothans
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
| | - Martin M. Reich
- Department of Neurology, University Hospital and Julius-Maximilian-University, 97080 Wuerzburg, Germany; (N.G.P.); (F.L.); (J.R.); (J.V.)
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14
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Tripathi M, Mehta S, Singla R, Ahuja CK, Tandalya N, Tuleasca C, Batish A, Mohindra S, Agrahari A, Kaur R. Vim stereotactic radiosurgical thalamotomy for drug-resistant idiopathic Holmes tremor: a case report. Acta Neurochir (Wien) 2021; 163:1867-1871. [PMID: 32676689 DOI: 10.1007/s00701-020-04489-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
We share our experience with stereotactic gamma knife thalamotomy (GKT) for medically refractory Holmes tremor (HT). A 22-year-old patient underwent gamma knife thalamotomy at ventrointermediate nucleus for disabling HT of the right upper limb. A single 4-mm isocenter was used to target the ventral intermediate nucleus with 130 Gy radiation. At 4 months follow up, we observed 84% improvement in his Fahn-Tolosa-Marin (FTM) rating scale with significant improvement in the right upper limb dystonic tremor. There was only subtle improvement in the ataxic component of the right lower limb. At 1 year after stereotactic GKT, there was sustained neurological improvement with no side effect, We present the stereotactic GKT as a treatment modality for drug-resistant HT. Moreover, it may be considered an alternate treatment modality especially in patients reluctant or contraindicated for any invasive surgical technique. CLINICAL TRIAL REGISTRATION NUMBER: Not required.
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15
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Iorio-Morin C, Hodaie M, Lozano AM. Adoption of focused ultrasound thalamotomy for essential tremor: why so much fuss about FUS? J Neurol Neurosurg Psychiatry 2021; 92:549-554. [PMID: 33563810 DOI: 10.1136/jnnp-2020-324061] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/27/2020] [Accepted: 12/22/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Focused ultrasound (FUS) was approved as a new treatment modality for essential tremor (ET) in 2016. The goal of this study was to quantify FUS adoption for ET and understand its drivers. METHODS The adoption of the various surgical options for ET was estimated using three measures: the number of presentations on the various surgical treatments for ET at specialised international meetings, the number of original papers published as identified by literature searches and the number of thalamotomy procedures performed worldwide for ET as provided by device manufacturers' registries. RESULTS First, we found that the number of presentations related to lesioning procedures is increasing relative to deep brain stimulation (DBS) at international meetings. Second, there are already more publications on FUS (93) than stereotactic radiosurgery (SRS) (68) or radiofrequency (43) for ET, although they still lag behind DBS papers (750). Third, the number of annual FUS thalamotomies performed for ET (n>1200 in 2019) in 44 centres has surpassed the annual procedures across 342 Gamma Knife units (n<400, 2018) but is yet to reach the number of DBS cases for ET estimated at over 2400/year. CONCLUSION FUS is being rapidly adopted for the treatment of ET. We hypothesise that its perceived minimally invasive nature coupled with the ability to perform intraoperative clinical assessments, its immediate effects and active marketing efforts are contributing factors. As lesioning modalities for the treatment of ET are reappraised, the superior popularity of FUS over SRS appears to arise for reasons other than differences in clinical outcomes.
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Affiliation(s)
- Christian Iorio-Morin
- Neurosurgery, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
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16
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Gamma Knife Thalamotomy for a Medically Refractory Tremors: Longitudinal Evaluation of Clinical Effects and MRI Response Patterns. ACTA NEUROCHIRURGICA. SUPPLEMENT 2021; 128:127-132. [PMID: 34191069 DOI: 10.1007/978-3-030-69217-9_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The present longitudinal study evaluated the results of Gamma Knife surgery (GKS) for medically refractory tremors. METHODS The outcome after Gamma Knife thalamotomy targeting the ventral intermediate nucleus (VIM) was analyzed in 17 patients (9 men and 8 women; mean age 72 years) with either Parkinson's disease or an essential tremor, who were followed up for at least 2 years after treatment. Clinical and magnetic resonance imaging (MRI) examinations were done before and every 3 months after GKS. RESULTS The mean rates of symptom improvement (a decrease in the tremor frequency) were 6%, 39%, 63%, and 64% at 3, 6, 12, and 24 months after treatment, respectively. The defined MRI response patterns included a minimum reaction (in 3 patients), a normal reaction (in 11 patients), and a hyperreaction (in 3 patients). They were not associated with any evaluated pretreatment, radiosurgical, or outcome parameter, although 2 patients with a hyperreaction exhibited mild-to-moderate motor weakness in the contralateral limbs. Linear contrasting of the border between the thalamus and the internal capsule adjacent to the lesion site was noted on follow-up MRI in 13 cases and was associated with a higher symptom improvement rate. CONCLUSION GKS allows effective and safe management of medically refractory tremors. The treatment is characterized by variable MRI response patterns. Some imaging findings during follow-up may be associated with clinical effects.
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17
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Tripathi M, Aulakh S. Is Glutamine Responsible for the Radiosensitivity of Subthalamic Nucleus? Stereotact Funct Neurosurg 2020; 99:176-177. [PMID: 33227792 DOI: 10.1159/000510889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India,
| | - Sonikpreet Aulakh
- Translational Neuro-Oncology, West Virginia Cancer Institute, West Virginia University, Morgantown, West Virginia, USA
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18
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Wang KL, Ren Q, Chiu S, Patel B, Meng FG, Hu W, Shukla AW. Deep brain stimulation and other surgical modalities for the management of essential tremor. Expert Rev Med Devices 2020; 17:817-833. [PMID: 33081571 DOI: 10.1080/17434440.2020.1806709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Surgical treatments are considered for essential tremor (ET) when patients do not respond to oral pharmacological therapies. These treatments mainly comprise radiofrequency (RF) thalamotomy, gamma knife radiosurgery (GKRS), deep brain stimulation (DBS), and focused ultrasound (FUS) procedures. AREAS COVERED We reviewed the strengths and weaknesses of each procedure and clinical outcomes for 7 RF studies (n = 85), 11 GKRS (n = 477), 33 DBS (n = 1061), and 13 FUS studies (n = 368). A formal comparison was not possible given the heterogeneity in studies. Improvements were about 42%-90% RF, 10%-79% GKRS, 45%-83% DBS, 42%-83% FUS at short-term follow-up (<12 months) and were about 54%-82% RF, 11%-84% GKRS, 18%-92% DBS, and 42%-80% FUS at long-term follow-up (>12 months). EXPERT OPINION We found DBS with inherent advantages of being an adjustable and reversible procedure as the most frequently employed surgical procedure for control of ET symptoms. FUS is a promising procedure but has limited applicability for unilateral control of symptoms. RF is invasive, and GKRS has unpredictable delayed effects. Each of these surgical modalities has advantages and limitations that need consideration when selecting a treatment for the ET patients.
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Affiliation(s)
- Kai-Liang Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University , Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China
| | - Qianwei Ren
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China
| | - Shannon Chiu
- Department of Neurology, University of Florida College of Medicine , Gainesville, FL, USA
| | - Bhavana Patel
- Department of Neurology, University of Florida College of Medicine , Gainesville, FL, USA
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University , Beijing, China
| | - Wei Hu
- Department of Neurology, University of Florida College of Medicine , Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Department of Neurology, University of Florida College of Medicine , Gainesville, FL, USA
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19
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Draoui A, El Hiba O, Aimrane A, El Khiat A, Gamrani H. Parkinson's disease: From bench to bedside. Rev Neurol (Paris) 2020; 176:543-559. [DOI: 10.1016/j.neurol.2019.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 01/12/2023]
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20
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Outcomes and Adverse Effects of Deep Brain Stimulation on the Ventral Intermediate Nucleus in Patients with Essential Tremor. Neural Plast 2020; 2020:2486065. [PMID: 32802034 PMCID: PMC7416257 DOI: 10.1155/2020/2486065] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/24/2020] [Accepted: 07/03/2020] [Indexed: 01/17/2023] Open
Abstract
Objective This study was aimed at identifying the potential outcome predictors, comparing the efficacy in patients with different tremor characteristics, and summarizing the adverse effect rates (AERs) of deep brain stimulation on the ventral intermediate nucleus (VIM-DBS) for essential tremor (ET). Methods An extensive search of articles published to date in 2019 was conducted, and two main aspects were analyzed. Improvement was calculated as a percentage of change in any objective tremor rating scale (TRS) and analyzed by subgroup analyses of patients' tremor characteristics, laterality, and stimulation parameters. Furthermore, the AERs were analyzed as follows: the adverse effects (AEs) were classified as stimulation-related, surgical-related, or device-related effects. A simple regression analysis was used to identify the potential prognostic factors, and a two-sample mean-comparison test was used to verify the statistical significance of the subgroup analyses. Results Forty-six articles involving 1714 patients were included in the meta-analysis. The pooled improvement in any objective TRS score was 61.3% (95% CI: 0.564-0.660) at the mean follow-up visit (20.0 ± 17.3 months). The midline and extremity symptoms showed consistent improvement (P = 0.440), and the results of the comparison of postural and kinetic tremor were the same (P = 0.219). In addition, the improvement in rest tremor was similar to that in action tremor (OR = 2.759, P = 0.120). In the simple regression analysis, the preoperative Fahn-Tolosa-Marin Tremor Rating Scale (FTM-TRS) scores and follow-up time were negatively correlated with the percentage change in any objective TRS score (P < 0.05). The most common adverse event was dysarthria (10.5%), which is a stimulation-related AE (23.6%), while the rates of the surgical-related and device-related AEs were 6.4% and 11.5%, respectively. Conclusion VIM-DBS is an efficient and safe surgical method in ET, and the efficacy was not affected by the body distribution of tremor, age at surgery, and disease duration. Lower preoperative FTM-TRS scores likely indicate greater improvement, and the effect of VIM-DBS declines over time.
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21
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Franzini A, Moosa S, Servello D, Small I, DiMeco F, Xu Z, Elias WJ, Franzini A, Prada F. Ablative brain surgery: an overview. Int J Hyperthermia 2020; 36:64-80. [PMID: 31537157 DOI: 10.1080/02656736.2019.1616833] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Ablative therapies have been used for the treatment of neurological disorders for many years. They have been used both for creating therapeutic lesions within dysfunctional brain circuits and to destroy intracranial tumors and space-occupying masses. Despite the introduction of new effective drugs and neuromodulative techniques, which became more popular and subsequently caused brain ablation techniques to fall out favor, recent technological advances have led to the resurgence of lesioning with an improved safety profile. Currently, the four main ablative techniques that are used for ablative brain surgery are radiofrequency thermoablation, stereotactic radiosurgery, laser interstitial thermal therapy and magnetic resonance-guided focused ultrasound thermal ablation. Object: To review the physical principles underlying brain ablative therapies and to describe their use for neurological disorders. Methods: The literature regarding the neurosurgical applications of brain ablative therapies has been reviewed. Results: Ablative treatments have been used for several neurological disorders, including movement disorders, psychiatric disorders, chronic pain, drug-resistant epilepsy and brain tumors. Conclusions: There are several ongoing efforts to use novel ablative therapies directed towards the brain. The recent development of techniques that allow for precise targeting, accurate delivery of thermal doses and real-time visualization of induced tissue damage during the procedure have resulted in novel techniques for cerebral ablation such as magnetic resonance-guided focused ultrasound or laser interstitial thermal therapy. However, older techniques such as radiofrequency thermal ablation or stereotactic radiosurgery still have a pivotal role in the management of a variety of neurological disorders.
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Affiliation(s)
- Andrea Franzini
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA.,Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta , Milan , Italy
| | - Shayan Moosa
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA
| | - Domenico Servello
- Department of Neurosurgery, Galeazzi Research and Clinical Hospital , Milan , Italy
| | - Isabella Small
- Focused Ultrasound Foundation , Charlottesville , VA , USA
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta , Milan , Italy.,Department of Pathophysiology and Transplantation, University of Milan , Milan , Italy.,Department of Neurological Surgery, Johns Hopkins Medical School , Baltimore , MD , USA
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA
| | - William Jeffrey Elias
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA
| | - Angelo Franzini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta , Milan , Italy
| | - Francesco Prada
- Department of Neurological Surgery, University of Virginia Health System , Charlottesville , VA , USA.,Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta , Milan , Italy.,Focused Ultrasound Foundation , Charlottesville , VA , USA
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22
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Paff M, Boutet A, Neudorfer C, Elias GJB, Germann J, Loh A, Kucharczyk W, Fasano A, Schwartz ML, Lozano AM. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy to Treat Essential Tremor in Nonagenarians. Stereotact Funct Neurosurg 2020; 98:182-186. [PMID: 32224617 DOI: 10.1159/000506817] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/13/2020] [Indexed: 11/19/2022]
Abstract
Essential tremor (ET) is a disabling movement disorder that is most prevalent among the elderly. While deep brain stimulation surgery targeting the ventral intermediate nucleus of the thalamus is commonly used to treat ET, the most elderly patients or those with multiple medical comorbidities may not qualify as surgical candidates. Magnetic resonance-guided focused ultrasound (MRgFUS) constitutes a less invasive modality that may be used to perform thalamotomy without the need for a burr hole craniotomy. Here, we report on 2 patients over the age of 90 years who benefited significantly from MRgFUS thalamotomy to relieve their symptoms and improve their quality of life. The procedure was well tolerated and performed safely in both patients. We conclude that age should not be a limiting factor in the treatment of patients with MRgFUS.
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Affiliation(s)
| | - Alexandre Boutet
- University Health Network, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Aaron Loh
- University Health Network, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- University Health Network, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - 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 Brain Institute, Toronto, Ontario, Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- University Health Network, Toronto, Ontario, Canada, .,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Ontario, Ontario, Canada,
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23
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Drummond PS, Pourfar MH, Hill TC, Mogilner AY, Kondziolka DS. Subthalamic Gamma Knife Radiosurgery in Parkinson's Disease: A Cautionary Tale. Stereotact Funct Neurosurg 2020; 98:110-117. [PMID: 32101861 DOI: 10.1159/000505709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/30/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) targeting the subthalamic nucleus (STN) has been shown to reliably improve several symptoms of Parkinson's disease (PD) in appropriately selected patients. Various factors may preclude patients from undergoing DBS and for them, non-invasive lesion-based therapies such as focused ultrasound and Gamma Knife (GK) radiosurgery may present a safer alternative. MATERIALS AND METHODS Based on preliminary positive reports of STN GK for PD, we conducted a prospective, open-label, single-center, pilot study in PD patients deemed potential candidates for unilateral DBS based on their disease characteristics, but contraindicated due to age >74, an irreversible bleeding diathesis, or significant comorbid medical disease. Stereotactic MRI-guided GK radiosurgery was performed using a single 110- or 120-Gy dose targeting the STN contralateral to the more symptomatic extremity. Clinical follow-up and imaging assessed the safety and efficacy of the procedure over a 12-month period. RESULTS Four PD patients with medication-refractory tremors and disabling dyskinesias underwent unilateral STN GK radiosurgery. Contraindications to DBS included high-risk comorbid cardiovas-cular disease in 3 patients and an irreversible bleeding diathesis in 1. There were no immediate post-procedural adverse events. One patient who underwent left STN GK radiosurgery developed right hemiparesis and dysarthria 7 months post-procedure followed by hospitalization at 9 months for bacterial endocarditis and liver failure from which he died. The remaining 3 patients were free of adverse events up to 12 months post-procedure and experienced a reduction in contralateral rigidity, bradykinesia, and tremor. Upon extended follow-up, 2 patients developed subacute worsening of gait. One died at 16 months due to complications of a fall whereas the other saw no change in gait up to 42 months post-procedure. All 3 patients with adverse events demonstrated a hyper-response in the targeted area on follow-up neuroimaging. DISCUSSION/CONCLUSION Despite the potential for clinical improvement, our results suggest that unilateral STN GK radiosurgery should be approached cautiously in medically frail PD patients who may be at higher risk of GK hyper-response and neurologic complications.
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Affiliation(s)
| | - Michael H Pourfar
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Travis C Hill
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
| | - Alon Y Mogilner
- Department of Neurosurgery, NYU Langone Health, New York, New York, USA
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24
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Jorge J, Gretsch F, Najdenovska E, Tuleasca C, Levivier M, Maeder P, Gallichan D, Marques JP, Bach Cuadra M. Improved susceptibility-weighted imaging for high contrast and resolution thalamic nuclei mapping at 7T. Magn Reson Med 2020; 84:1218-1234. [PMID: 32052486 DOI: 10.1002/mrm.28197] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The thalamus is an important brain structure and neurosurgical target, but its constituting nuclei are challenging to image non-invasively. Recently, susceptibility-weighted imaging (SWI) at ultra-high field has shown promising capabilities for thalamic nuclei mapping. In this work, several methodological improvements were explored to enhance SWI quality and contrast, and specifically its ability for thalamic imaging. METHODS High-resolution SWI was performed at 7T in healthy participants, and the following techniques were applied: (a) monitoring and retrospective correction of head motion and B0 perturbations using integrated MR navigators, (b) segmentation and removal of venous vessels on the SWI data using vessel enhancement filtering, and (c) contrast enhancement by tuning the parameters of the SWI phase-magnitude combination. The resulting improvements were evaluated with quantitative metrics of image quality, and by comparison to anatomo-histological thalamic atlases. RESULTS Even with sub-millimeter motion and natural breathing, motion and field correction produced clear improvements in both magnitude and phase data quality (76% and 41%, respectively). The improvements were stronger in cases of larger motion/field deviations, mitigating the dependence of image quality on subject performance. Optimizing the SWI phase-magnitude combination yielded substantial improvements in image contrast, particularly in the thalamus, well beyond previously reported SWI results. The atlas comparisons provided compelling evidence of anatomical correspondence between SWI features and several thalamic nuclei, for example, the ventral intermediate nucleus. Vein detection performed favorably inside the thalamus, and vein removal further improved visualization. CONCLUSION Altogether, the proposed developments substantially improve high-resolution SWI, particularly for thalamic nuclei imaging.
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Affiliation(s)
- João Jorge
- Medical Image Analysis Laboratory, Center for Biomedical Imaging (CIBM), University of Lausanne, Lausanne, Switzerland.,Laboratory for Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Frédéric Gretsch
- Laboratory for Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Elena Najdenovska
- Medical Image Analysis Laboratory, Center for Biomedical Imaging (CIBM), University of Lausanne, Lausanne, Switzerland.,Department of Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Philippe Maeder
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Daniel Gallichan
- Cardiff University Brain Research Imaging Centre, School of Engineering, Cardiff University, Cardiff, UK
| | - José P Marques
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Meritxell Bach Cuadra
- Medical Image Analysis Laboratory, Center for Biomedical Imaging (CIBM), University of Lausanne, Lausanne, Switzerland.,Department of Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.,Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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25
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Gallay MN, Moser D, Jeanmonod D. MR-guided focused ultrasound cerebellothalamic tractotomy for chronic therapy-resistant essential tremor: anatomical target reappraisal and clinical results. J Neurosurg 2020; 134:376-385. [PMID: 32032945 DOI: 10.3171/2019.12.jns192219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In addition to the well-recognized ventral intermediate nucleus (Vim) thalamotomy for the treatment of chronic therapy-resistant essential tremor (ET), an alternative approach targeting the posterior part of the subthalamus was proposed in the 1960s and early 1970s and then was reactualized as cerebellothalamic tractotomy (CTT) with the advent of MR-guided focused ultrasound (MRgFUS) surgery. The goal of this study was to improve target coverage and thus efficacy (i.e., tremor control and its consistency). The authors undertook a histological reappraisal of the CTT target and proposed a targeting strategy of the MRgFUS CTT based on 1) the MR visualization of the center of the red nucleus and 2) the application of preplanned target subunits realized with short sonications under thermal dose control. This study was aimed at demonstrating the efficacy and risk profile of this approach against chronic therapy-resistant ET. METHODS Ten consecutive patients suffering from chronic therapy-resistant ET benefited from a unilateral MRgFUS CTT and were followed over the course of 1 year. Primary endpoints were subjective tremor relief, Clinical Rating Scale for Tremor (CRST) score, activities of daily living (ADL) score, and the hand function (HF) scores HF16 and HF32. Histological reappraisal of the target led the authors to propose a standardized targeting protocol for MRgFUS CTT. Thermal doses for 18 and 240 cumulative equivalent minutes at 43°C were calculated and correlated with intraoperative and 2 days postoperative T2-weighted MR images. RESULTS The mean ± SD for the baseline CRST score was 48 ± 12; the score was 16 ± 7 at 3 months, and 17 ± 8 at 1 year. The mean tremor relief rated by the patients for the operated side was 95% after 2 days, 96% at 3 months, and 93% at 1 year. The mean HF16 was 11.0 ± 2.1 at baseline, 0.7 ± 0.7 at 3 months, and 0.8 ± 0.9 at 1 year (93% mean reduction). The minimum reduction for the HF16 at 1 year was 78%. There was a 51% reduction of the mean ADL score at 1 year. There was no bleeding or infection. Gait difficulties, only detectable on tandem gait, were increased in 3 patients and reduced in 2 patients at 1 year. There was no dysarthria. CONCLUSIONS The authors' results suggest that MRgFUS CTT is a very effective treatment option for therapy-resistant ET.
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Essential Tremor: Lesions. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Iacopino DG, Gagliardo C, Giugno A, Giammalva GR, Napoli A, Maugeri R, Graziano F, Valentino F, Cosentino G, D'Amelio M, Bartolotta TV, Catalano C, Fierro B, Midiri M, Lagalla R. Preliminary experience with a transcranial magnetic resonance-guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson's disease. Neurosurg Focus 2019; 44:E7. [PMID: 29385927 DOI: 10.3171/2017.11.focus17614] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Transcranial magnetic resonance-guided focused ultrasound surgery (tcMRgFUS) is one of the emerging noninvasive technologies for the treatment of neurological disorders such as essential tremor (ET), idiopathic asymmetrical tremor-dominant Parkinson's disease (PD), and neuropathic pain. In this clinical series the authors present the preliminary results achieved with the world's first tcMRgFUS system integrated with a 1.5-T MRI unit. METHODS The authors describe the results of tcMRgFUS in a sample of patients with ET and with PD who underwent the procedure during the period from January 2015 to September 2017. A monolateral ventralis intermedius nucleus (VIM) thalamic ablation was performed in both ET and PD patients. In all the tcMRgFUS treatments, a 1.5-T MRI scanner was used for both planning and monitoring the procedure. RESULTS During the study period, a total of 26 patients underwent tcMRgFUS thalamic ablation for different movement disorders. Among these patients, 18 were diagnosed with ET and 4 were affected by PD. All patients with PD were treated using tcMRgFUS thalamic ablation and all completed the procedure. Among the 18 patients with ET, 13 successfully underwent tcMRgFUS, 4 aborted the procedure during ultrasound delivery, and 1 did not undergo the tcMRgFUS procedure after stereotactic frame placement. Two patients with ET were not included in the results because of the short follow-up duration at the time of this study. A monolateral VIM thalamic ablation in both ET and PD patients was performed. All the enrolled patients were evaluated before the treatment and 2 days after, with a clinical control of the treatment effectiveness using the graphic items of the Fahn-Tolosa-Marin tremor rating scale. A global reevaluation was performed 3 months (17/22 patients) and 6 months (11/22 patients) after the treatment; the reevaluation consisted of clinical questionnaires, neurological tests, and video recordings of the tests. All the ET and PD treated patients who completed the procedure showed an immediate amelioration of tremor severity, with no intra- or posttreatment severe permanent side effects. CONCLUSIONS Although this study reports on a small number of patients with a short follow-up duration, the tcMRgFUS procedure using a 1.5-T MRI unit resulted in a safe and effective treatment option for motor symptoms in patients with ET and PD. To the best of the authors' knowledge, this is the first clinical series in which thalamotomy was performed using tcMRgFUS integrated with a 1.5-T magnet.
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Affiliation(s)
- Domenico Gerardo Iacopino
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Cesare Gagliardo
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo
| | - Antonella Giugno
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Giuseppe Roberto Giammalva
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Alessandro Napoli
- Radiology Section, Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" University of Rome; and
| | - Rosario Maugeri
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Francesca Graziano
- Unit of Neurosurgery, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo
| | - Francesca Valentino
- Unit of Neurology, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Giuseppe Cosentino
- Unit of Neurology, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Marco D'Amelio
- Unit of Neurology, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Tommaso Vincenzo Bartolotta
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo
| | - Carlo Catalano
- Radiology Section, Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" University of Rome; and
| | - Brigida Fierro
- Unit of Neurology, Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | - Massimo Midiri
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo
| | - Roberto Lagalla
- Section of Radiological Sciences, Department of Biopathology and Medical Biotechnologies, University of Palermo
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Mohammed N, Patra D, Nanda A. A meta-analysis of outcomes and complications of magnetic resonance-guided focused ultrasound in the treatment of essential tremor. Neurosurg Focus 2019; 44:E4. [PMID: 29385917 DOI: 10.3171/2017.11.focus17628] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel technique that uses high-intensity focused ultrasound to achieve target ablation. Like a lens focusing the sun's rays, the ultrasound waves are focused to generate heat. This therapy combines the noninvasiveness of Gamma Knife thalamotomy and the real-time ablation of deep brain stimulation with acceptable complication rates. The aim of this study was to analyze the overall outcomes and complications of MRgFUS in the treatment of essential tremor (ET). METHODS A meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was made by searching PubMed, Cochrane library database, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Patients with the diagnosis of ET who were treated with MRgFUS were included in the study. The change in the Clinical Rating Scale for Tremor (CRST) score after treatment was analyzed. The improvement in disability was assessed with the Quality of Life in Essential Tremor Questionnaire (QUEST) score. The pooled data were analyzed by the DerSimonian-Laird random-effects model. Tests for bias and heterogeneity were performed. RESULTS Nine studies with 160 patients who had ET were included in the meta-analysis. The ventral intermediate nucleus was the target in 8 of the studies. The cerebellothalamic tract was targeted in 1 study. There was 1 randomized controlled trial, 6 studies were retrospective, and 2 were prospective. The mean number of sonications given in various studies ranged from 11 ± 3.2 to 22.5 ± 7.5 (mean ± SD). The maximum delivered energy ranged from 10,320 ± 4537 to 14,497 ± 6695 Joules. The mean of peak temperature reached ranged from 53°C ± 2.3°C to 62.0°C ± 2.5°C. On meta-analysis with the random-effects model, the pooled percentage improvements in the CRST Total, CRST Part A, CRST Part C, and QUEST scores were 62.2%, 62.4%, 69.1%, and 46.5%, respectively. Dizziness was the most common in-procedure complication, occurring in 45.5%, followed by nausea and vomiting in 26.85% (pooled percentage). At 3 months, ataxia was the most common complication, occurring in 32.8%, followed by paresthesias in 25.1% of the patients. At 12 months posttreatment, the ataxia had significantly recovered and paresthesias became the most common persisting complication, at 15.3%. CONCLUSIONS The MRgFUS therapy for ET significantly improves the CRST scores and improves the quality of life in patients with ET, with an acceptable complication rate. Therapy with MRgFUS is a promising frontier in functional neurosurgery.
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Affiliation(s)
- Nasser Mohammed
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Devi Patra
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Anil Nanda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana
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Sharma S, Pandey S. Treatment of essential tremor: current status. Postgrad Med J 2019; 96:84-93. [DOI: 10.1136/postgradmedj-2019-136647] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/14/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022]
Abstract
Essential tremor is the most common cause of tremor involving upper limbs, head and voice. The first line of treatment for limb tremor is pharmacotherapy with propranolol or primidone. However, these two drugs reduce the tremor severity by only half. In medication refractory and functionally disabling tremor, alternative forms of therapy need to be considered. Botulinum toxin injections are likely efficacious for limb, voice and head tremor but are associated with side effects. Surgical interventions include deep brain stimulation; magnetic resonance-guided focused ultrasound and thalamotomy for unilateral and deep brain stimulation for bilateral procedures. Recent consensus classification for essential tremor has included a new subgroup, ‘Essential tremor plus’, who have associated subtle neurological ‘soft signs’, such as dystonic posturing of limbs and may require a different treatment approach. In this review, we have addressed the current management of essential tremor with regard to different anatomical locations of tremor as well as different modalities of treatment.
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Tuleasca C, Régis J, Najdenovska E, Witjas T, Girard N, Bolton T, Delaire F, Vincent M, Faouzi M, Thiran JP, Bach Cuadra M, Levivier M, Van de Ville D. Pretherapeutic resting-state fMRI profiles are associated with MR signature volumes after stereotactic radiosurgical thalamotomy for essential tremor. J Neurosurg 2019; 129:63-71. [PMID: 30544321 DOI: 10.3171/2018.7.gks18752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEssential tremor (ET) is the most common movement disorder. Drug-resistant ET can benefit from standard stereotactic deep brain stimulation or radiofrequency thalamotomy or, alternatively, minimally invasive techniques, including stereotactic radiosurgery (SRS) and high-intensity focused ultrasound, at the level of the ventral intermediate nucleus (Vim). The aim of the present study was to evaluate potential correlations between pretherapeutic interconnectivity (IC), as depicted on resting-state functional MRI (rs-fMRI), and MR signature volume at 1 year after Vim SRS for tremor, to be able to potentially identify hypo- and hyperresponders based only on pretherapeutic neuroimaging data.METHODSSeventeen consecutive patients with ET were included, who benefitted from left unilateral SRS thalamotomy (SRS-T) between September 2014 and August 2015. Standard tremor assessment and rs-fMRI were acquired pretherapeutically and 1 year after SRS-T. A healthy control group was also included (n = 12). Group-level independent component analysis (ICA; only n = 17 for pretherapeutic rs-fMRI) was applied. The mean MR signature volume was 0.125 ml (median 0.063 ml, range 0.002-0.600 ml). The authors correlated baseline IC with 1-year MR signatures within all networks. A 2-sample t-test at the level of each component was first performed in two groups: group 1 (n = 8, volume < 0.063 ml) and group 2 (n = 9, volume ≥ 0.063 ml). These groups did not statistically differ by age, duration of symptoms, baseline ADL score, ADL point decrease at 1 year, time to tremor arrest, or baseline tremor score on the treated hand (TSTH; p > 0.05). An ANOVA was then performed on each component, using individual subject-level maps and continuous values of 1-year MR signatures, correlated with pretherapeutic IC.RESULTSUsing 2-sample t-tests, two networks were found to be statistically significant: network 3, including the brainstem, motor cerebellum, bilateral thalamus, and left supplementary motor area (SMA) (pFWE = 0.004, cluster size = 94), interconnected with the red nucleus (MNI -2, -22, -32); and network 9, including the brainstem, posterior insula, bilateral thalamus, and left SMA (pFWE = 0.002, cluster size = 106), interconnected with the left SMA (MNI 24, -28, 44). Higher pretherapeutic IC was associated with higher MR volumes, in a network including the anterior default-mode network and bilateral thalamus (ANOVA, pFWE = 0.004, cluster size = 73), interconnected with cerebellar lobule V (MNI -12, -70, -22). Moreover, in the same network, radiological hyporesponders presented with negative IC values.CONCLUSIONSThese findings have clinical implications for predicting MR signature volumes after SRS-T. Here, using pretherapeutic MRI and data processing without prior hypothesis, the authors showed that pretherapeutic network interconnectivity strength predicts 1-year MR signature volumes following SRS-T.
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Affiliation(s)
- Constantin Tuleasca
- 1Neurosurgery Service and Gamma Knife Center.,4Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Jean Régis
- 5Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, and
| | - Elena Najdenovska
- 2Medical Image Analysis Laboratory (MIAL) and Department of Radiology, Centre d'Imagerie BioMédicale (CIBM), and
| | | | - Nadine Girard
- 7AMU, CRMBM UMR CNRS 7339, Faculté de Médecine et APHM, Hôpital Timone, Department of Diagnostic and Interventional Neuroradiology, Marseille, France
| | - Thomas Bolton
- 8Medical Image Processing Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Francois Delaire
- 5Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, and
| | - Marion Vincent
- 5Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, and
| | - Mohamed Faouzi
- 9Institute of Social and Preventive Medicine, Lausanne, Switzerland; and
| | - Jean-Philippe Thiran
- 3Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.,4Faculty of Biology and Medicine, University of Lausanne, Switzerland.,10Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Meritxell Bach Cuadra
- 2Medical Image Analysis Laboratory (MIAL) and Department of Radiology, Centre d'Imagerie BioMédicale (CIBM), and.,3Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Marc Levivier
- 1Neurosurgery Service and Gamma Knife Center.,4Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Dimitri Van de Ville
- 8Medical Image Processing Laboratory, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland.,11University of Geneva, Faculty of Medicine, Geneva, Switzerland
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Fasano A, Helmich RC. Tremor habituation to deep brain stimulation: Underlying mechanisms and solutions. Mov Disord 2019; 34:1761-1773. [PMID: 31433906 DOI: 10.1002/mds.27821] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
DBS of the ventral intermediate nucleus is an extremely effective treatment for essential tremor, although a waning benefit is observed after a variable time in a variable proportion of patients (ranging from 0% to 73%), a concept historically defined as "tolerance." Tolerance is currently an established concept in the medical community, although there is debate on its real existence. In fact, very few publications have actually addressed the problem, thus making tolerance a typical example of science based on "eminence rather than evidence." The underpinnings of the phenomena associated with the progressive loss of DBS benefit are not fully elucidated, although the interplay of different-not mutually exclusive-factors has been advocated. In this viewpoint, we gathered the evidence explaining the progressive loss of benefit observed after DBS. We grouped these factors in three categories: disease-related factors (tremor etiology and progression); surgery-related factors (electrode location, microlesional effect and placebo); and stimulation-related factors (not optimized stimulation, stimulation-induced side effects, habituation, and tremor rebound). We also propose possible pathophysiological explanations for the phenomenon and define a nomenclature of the associated features: early versus late DBS failure; tremor rebound versus habituation (to be preferred over tolerance). Finally, we provide a practical approach for preventing and treating this loss of DBS benefit, and we draft a possible roadmap for the research to come. © 2019 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
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ALLEN BRENDONC, CHARLES STEVENK. EFFECT OF GYROSCOPE PARAMETERS ON GYROSCOPIC TREMOR SUPPRESSION IN A SINGLE DEGREE OF FREEDOM. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419500246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although tremor is one of the most common movement disorders, there are few effective tremor-suppressing options available to patients. Gyrostabilization is a potential option, but we do not currently know how to optimize gyrostabilization for tremor suppression. To address this gap, we present a systematic investigation of how gyrostabilizer parameters affect tremor suppression in a single degree of freedom (DOF). A simple model with a single DOF at the wrist and a gyroscope mounted on the back of the hand was used to focus on the most basic effects. We simulated the frequency response of the system (hand + gyroscope) to a tremorogenic input torque at the wrist. Varying system parameters one at a time, we determined the effect of individual parameters on the system’s frequency response. To minimize the bandwidth without adding significant inertia, the inertia and spin speed of the flywheel should be as high as design constraints allow, whereas the distance from the wrist joint axis to the gyroscope and the precession stiffness and damping should be kept as low as possible. The results demonstrate the potential of gyroscopic tremor suppression and can serve as foundation for further investigations of gyroscopic tremor suppression in the upper limb.
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Affiliation(s)
- BRENDON C. ALLEN
- Mechanical Engineering, Brigham Young University, 350 EB, Provo, UT 84602, USA
| | - STEVEN K. CHARLES
- Mechanical Engineering and Neuroscience, Brigham Young University, 350 EB, Provo, UT 84602, USA
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Tuleasca C, Bolton TAW, Régis J, Najdenovska E, Witjas T, Girard N, Delaire F, Vincent M, Faouzi M, Thiran JP, Bach Cuadra M, Levivier M, Van De Ville D. Normalization of aberrant pretherapeutic dynamic functional connectivity of extrastriate visual system in patients who underwent thalamotomy with stereotactic radiosurgery for essential tremor: a resting-state functional MRI study. J Neurosurg 2019; 132:1792-1801. [PMID: 31075777 DOI: 10.3171/2019.2.jns183454] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The tremor circuitry has commonly been hypothesized to be driven by one or multiple pacemakers within the cerebello-thalamo-cortical pathway, including the cerebellum, contralateral motor thalamus, and primary motor cortex. However, previous studies, using multiple methodologies, have advocated that tremor could be influenced by changes within the right extrastriate cortex, at both the structural and functional level. The purpose of this work was to evaluate the role of the extrastriate cortex in tremor generation and further arrest after left unilateral stereotactic radiosurgery thalamotomy (SRS-T). METHODS The authors considered 12 healthy controls (HCs, group 1); 15 patients with essential tremor (ET, right-sided, drug-resistant; group 2) before left unilateral SRS-T; and the same 15 patients (group 3) 1 year after the intervention, to account for delayed effects. Blood oxygenation level-dependent functional MRI during resting state was used to characterize the dynamic interactions of the right extrastriate cortex, comparing HC subjects against patients with ET before and 1 year after SRS-T. In particular, the authors applied coactivation pattern analysis to extract recurring whole-brain spatial patterns of brain activity over time. RESULTS The authors found 3 different sets of coactivating regions within the right extrastriate cortex in HCs and patients with pretherapeutic ET, reminiscent of the "cerebello-visuo-motor," "thalamo-visuo-motor" (including the targeted thalamus), and "basal ganglia and extrastriate" networks. The occurrence of the first pattern was decreased in pretherapeutic ET compared to HCs, whereas the other two patterns showed increased occurrences. This suggests a misbalance between the more prominent cerebellar circuitry and the thalamo-visuo-motor and basal ganglia networks. Multiple regression analysis showed that pretherapeutic standard tremor scores negatively correlated with the increased occurrence of the thalamo-visuo-motor network, suggesting a compensatory pathophysiological trait. Clinical improvement after SRS-T was related to changes in occurrences of the basal ganglia and extrastriate cortex circuitry, which returned to HC values after the intervention, suggesting that the dynamics of the extrastriate cortex had a role in tremor generation and further arrest after the intervention. CONCLUSIONS The data in this study point to a broader implication of the visual system in tremor generation, and not only through visual feedback, given its connections to the dorsal visual stream pathway and the cerebello-thalamo-cortical circuitry, with which its dynamic balance seems to be a crucial feature for reduced tremor. Furthermore, SRS-T seems to bring abnormal pretherapeutic connectivity of the extrastriate cortex to levels comparable to those of HC subjects.
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Affiliation(s)
- Constantin Tuleasca
- 1Service de Neurochirurgie, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire de Bicêtre, Paris.,2Faculté de Médecine, Sorbonne Université, Paris, France.,3Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne.,4Medical Image Analysis Laboratory and Department of Radiology-Center of Biomedical Imaging, Centre Hospitalier Universitaire Vaudois, Lausanne.,5Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne.,6Faculty of Biology and Medicine University of Lausanne
| | - Thomas A W Bolton
- 7Medical Image Processing Laboratory, École Polytechnique Fédérale de Lausanne, Switzerland.,8Department of Radiology and Medical Informatics, University of Geneva, Switzerland
| | - Jean Régis
- 9Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille
| | - Elena Najdenovska
- 4Medical Image Analysis Laboratory and Department of Radiology-Center of Biomedical Imaging, Centre Hospitalier Universitaire Vaudois, Lausanne
| | | | - Nadine Girard
- 11Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Unité Mixte de Recherche, Centre National de la Recherche Scientifique, Faculté de Médecine et Assistance Publique-Hôpitaux de Marseille, Hôpital Timone, Marseille, France
| | - Francois Delaire
- 9Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille
| | - Marion Vincent
- 9Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, CHU Timone, Marseille
| | - Mohamed Faouzi
- 12Institute of Social and Preventive Medicine, Lausanne; and
| | - Jean-Philippe Thiran
- 5Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne.,13Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Meritxell Bach Cuadra
- 4Medical Image Analysis Laboratory and Department of Radiology-Center of Biomedical Imaging, Centre Hospitalier Universitaire Vaudois, Lausanne.,5Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne
| | - Marc Levivier
- 3Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne.,6Faculty of Biology and Medicine University of Lausanne
| | - Dimitri Van De Ville
- 7Medical Image Processing Laboratory, École Polytechnique Fédérale de Lausanne, Switzerland.,8Department of Radiology and Medical Informatics, University of Geneva, Switzerland
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Lausanne checklist for safe stereotactic radiosurgery. Acta Neurochir (Wien) 2019; 161:721-727. [PMID: 30790090 DOI: 10.1007/s00701-019-03843-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Stereotactic radiosurgery (SRS) is increasingly used as a minimally invasive alternative in many neurosurgical conditions, including benign and malignant tumors, vascular malformations, and functional procedures. As for any surgical procedure, strict safety guidelines and checklists are necessary to avoid errors and the inherent unnecessary complications. With regard to the former, other groups have already reported human and/or technical errors. We describe our safety checklist for Gamma Knife radiosurgical procedures. METHODS We describe our checklist protocol after an experience gained over 1500 radiosurgical procedures, using Gamma Knife radiosurgery, performed over a period of 8 years, while employing the same list of items. Minor implementation has been performed over time to address some safety issues that could be improved. RESULTS Two types of checklist are displayed. One is related to the indications when a specific tissue volume is irradiated, including tumors or vascular disorders. The second corresponds to functional disorders, such as when the dose is prescribed to one specific point. Using these checklists, no human error had been reported during the past 8 years of practice in our institution. CONCLUSION The use of a safety checklist for SRS procedures promotes a zero-tolerance attitude for errors. This can lower the complications and is of major help in promoting multidisciplinary cooperation. We highly recommend the use of such tool, especially in the context of the increased use of SRS in the neurosurgical field.
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Dallapiazza RF, Lee DJ, De Vloo P, Fomenko A, Hamani C, Hodaie M, Kalia SK, Fasano A, Lozano AM. Outcomes from stereotactic surgery for essential tremor. J Neurol Neurosurg Psychiatry 2019; 90:474-482. [PMID: 30337440 PMCID: PMC6581115 DOI: 10.1136/jnnp-2018-318240] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/17/2018] [Accepted: 09/25/2018] [Indexed: 11/03/2022]
Abstract
There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful presentation and discussion of the benefits and drawbacks of each. We conducted a literature review to compare the attributes and make an appraisal of these various procedures. DBS was the most commonly reported treatment for ET. One-year tremor reductions ranged from 53% to 63% with unilateral Vim DBS. Similar improvements were demonstrated with RF (range, 74%-90%), RS (range, 48%-63%) and FUS thalamotomy (range, 35%-75%). Overall, bilateral Vim DBS demonstrated more improvement in tremor reduction since both upper extremities were treated (range, 66%-78%). Several studies show continued beneficial effects from DBS up to five years. Long-term follow-up data also support RF and gamma knife radiosurgical thalamotomy treatments. Quality of life measures were similarly improved among patients who received all treatments. Paraesthesias, dysarthria and ataxia were commonly reported adverse effects in all treatment modalities and were more common with bilateral DBS surgery. Many of the neurological complications were transient and resolved after surgery. DBS surgery had the added benefit of programming adjustments to minimise stimulation-related complications. Permanent neurological complications were most commonly reported for RF thalamotomy. Thalamic DBS is an effective, safe treatment with a long history. For patients who are medically unfit or reluctant to undergo DBS, several thalamic lesioning methods have parallel benefits to unilateral DBS surgery. Each of these surgical modalities has its own nuance for treatment and patient selection. These factors should be carefully considered by both neurosurgeons and patients when selecting an appropriate treatment for ET.
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Affiliation(s)
| | - Darrin J Lee
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Philippe De Vloo
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Anton Fomenko
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Clement Hamani
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
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Park Y, Jung NY, Na YC, Chang JW. Four‐year follow‐up results of magnetic resonance‐guided focused ultrasound thalamotomy for essential tremor. Mov Disord 2019; 34:727-734. [DOI: 10.1002/mds.27637] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/11/2019] [Accepted: 01/18/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yong‐Sook Park
- Department of NeurosurgeryChung‐Ang University College of Medicine Seoul Korea
| | - Na Young Jung
- Department of NeurosurgeryBrain Research Institute, Yonsei University College of Medicine Seoul Korea
| | - Young Cheol Na
- Department of NeurosurgeryCatholic Kwandong University College of Medicine, International St. Mary's Hospital Incheon Korea
| | - Jin Woo Chang
- Department of NeurosurgeryBrain Research Institute, Yonsei University College of Medicine Seoul Korea
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Najdenovska E, Tuleasca C, Jorge J, Maeder P, Marques JP, Roine T, Gallichan D, Thiran JP, Levivier M, Bach Cuadra M. Comparison of MRI-based automated segmentation methods and functional neurosurgery targeting with direct visualization of the Ventro-intermediate thalamic nucleus at 7T. Sci Rep 2019; 9:1119. [PMID: 30718634 PMCID: PMC6361927 DOI: 10.1038/s41598-018-37825-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 12/13/2018] [Indexed: 12/22/2022] Open
Abstract
The ventro-intermediate nucleus (Vim), as part of the motor thalamic nuclei, is a commonly used target in functional stereotactic neurosurgery for treatment of drug-resistant tremor. As it cannot be directly visualized on routinely used magnetic resonance imaging (MRI), its clinical targeting is performed using indirect methods. Recent literature suggests that the Vim can be directly visualized on susceptibility-weighted imaging (SWI) acquired at 7 T. Our work aims to assess the distinguishable Vim on 7 T SWI in both healthy-population and patients and, using it as a reference, to compare it with: (1) The clinical targeting, (2) The automated parcellation of thalamic subparts based on 3 T diffusion MRI (dMRI), and (3) The multi-atlas segmentation techniques. In 95.2% of the data, the manual outline was adjacent to the inferior lateral border of the dMRI-based motor-nuclei group, while in 77.8% of the involved cases, its ventral part enclosed the Guiot points. Moreover, the late MRI signature in the patients was always observed in the anterior part of the manual delineation and it overlapped with the multi-atlas outline. Overall, our study provides new insight on Vim discrimination through MRI and imply novel strategies for its automated segmentation, thereby opening new perspectives for standardizing the clinical targeting.
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Affiliation(s)
- Elena Najdenovska
- Centre d'Imagerie BioMédicale (CIBM), University of Lausanne (UNIL), Lausanne, Switzerland. .,Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.,Sorbonne Université, Faculté de Médecine, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, Service de Neurochirurgie, Le Kremlin Bicêtre, France
| | - João Jorge
- Centre d'Imagerie BioMédicale (CIBM), University of Lausanne (UNIL), Lausanne, Switzerland.,Laboratory for Functional and Metabolic Imaging, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Philippe Maeder
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - José P Marques
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Timo Roine
- Centre d'Imagerie BioMédicale (CIBM), University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Turku Brain and Mind Center, University of Turku, Turku, Finland
| | - Daniel Gallichan
- Cardiff University Brain Research Imaging Centre (CUBRIC), Cardiff University, Cardiff, UK
| | - Jean-Philippe Thiran
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Meritxell Bach Cuadra
- Centre d'Imagerie BioMédicale (CIBM), University of Lausanne (UNIL), Lausanne, Switzerland.,Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland.,Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Chiang VL, Chao ST, Tuleasca C, Foote MC, Lee CC, Mathieu D, Soliman H, Sahgal A. Proceedings of the 2018 next-generation Gamma Knife research meeting. J Neurosurg 2018; 129:5-9. [PMID: 30544302 DOI: 10.3171/2018.7.gks181206] [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] [Received: 05/01/2018] [Accepted: 07/19/2018] [Indexed: 11/06/2022]
Abstract
In order to determine what areas of research are a clinical priority, a small group of young Gamma Knife investigators was invited to attend a workshop discussion at the 19th International Leksell Gamma Knife Society Meeting. Two areas of interest and the need for future radiosurgical research involving multiple institutions were identified by the young investigators working group: 1) the development of additional imaging sequences to guide the understanding, treatment, and outcome tracking of diseases such as tremor, radiation necrosis, and AVM; and 2) trials to clarify the role of hypofractionation versus single-fraction radiosurgery in the treatment of large lesions such as brain metastases, postoperative cavities, and meningiomas.
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Affiliation(s)
- Veronica L Chiang
- 1Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Samuel T Chao
- 2Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Constantin Tuleasca
- 3Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV); Faculty of Biology and Medicine (FBM), University of Lausanne; and Signal Processing Laboratory (EPFL), Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Matthew C Foote
- 4Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Cheng-Chia Lee
- 5Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and School of Medicine, National Yan-Min University, Taipei, Taiwan
| | - David Mathieu
- 6Department of Neurosurgery, Department of Surgery, Université de Sherbrooke, Quebec, Canada; and
| | - Hany Soliman
- 7Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Arjun Sahgal
- 7Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Langford BE, Ridley CJA, Beale RC, Caseby SCL, Marsh WJ, Richard L. Focused Ultrasound Thalamotomy and Other Interventions for Medication-Refractory Essential Tremor: An Indirect Comparison of Short-Term Impact on Health-Related Quality of Life. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1168-1175. [PMID: 30314617 DOI: 10.1016/j.jval.2018.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/21/2018] [Accepted: 03/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Up to 50% of essential tremor patients are refractory to medication and require alternative treatment to achieve tremor relief. This study aimed to identify and analyze evidence supporting the use of the emerging magnetic resonance-guided focused ultrasound (MRgFUS) compared to alternative stimulatory and ablative interventions for the treatment of medication-refractory essential tremor: radiofrequency thalamotomy, unilateral deep brain stimulation (DBS), and stereotactic radiosurgery. METHODS A systematic literature review was conducted to identify clinical, health-related quality of life (HRQoL), and economic evidence for each intervention. Because of the lack of comparative evidence captured, a feasibility assessment was performed to determine possible comparisons between interventions, and newly established matching-adjusted indirect comparison and simulated treatment comparison techniques were used to conduct a comparison between unilateral DBS aggregate data and MRgFUS individual patient data. RESULTS The systematic literature review identified 1,559 records, and screening yielded 46 relevant articles. The captured studies demonstrated that radiofrequency thalamotomy, DBS, stereotactic radiosurgery, and MRgFUS all exhibit clinical efficacy, with variation in onset and duration of tremor relief, and are each associated with a unique safety profile. The matching-adjusted indirect comparison and simulated treatment comparison results demonstrated no evidence of a difference in efficacy (measured by Clinical Rating Scale for Tremor Total) and HRQoL (measured by Clinical Rating Scale for Tremor Part C) outcomes between MRgFUS and unilateral DBS in the short term (≤12 months). CONCLUSIONS This study provides preliminary evidence that MRgFUS could elicit similar short-term tremor- and HRQoL-related benefits to DBS, the current standard of care, and allowed for the first robust statistical comparison between these interventions.
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40
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Rajah G, Saber H, Singh R, Rangel-Castilla L. Endovascular delivery of leads and stentrodes and their applications to deep brain stimulation and neuromodulation: a review. Neurosurg Focus 2018; 45:E19. [DOI: 10.3171/2018.4.focus18130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neuromodulation and deep brain stimulation (DBS) have been increasingly used in many neurological ailments, including essential tremor, Parkinson’s disease, epilepsy, and more. Yet for many patients and practitioners the desire to utilize these therapies is met with caution, given the need for craniotomy, lead insertion through brain parenchyma, and, at many times, bilateral invasive procedures. Currently endovascular therapy is a standard of care for emergency thrombectomy, aneurysm treatment, and other vascular malformation/occlusive disease of the cerebrum. Endovascular techniques and delivery catheters have advanced greatly in both their ability to safely reach remote brain locations and deliver devices. In this review the authors discuss minimally invasive endovascular delivery of devices and neural stimulating and recording from cortical and DBS targets via the neurovascular network.
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Affiliation(s)
- Gary Rajah
- Departments of 1Neurosurgery and
- 3Wayne State University School of Medicine, Detroit, Michigan; and
| | - Hamidreza Saber
- 2Neurology, Wayne State University, and
- 3Wayne State University School of Medicine, Detroit, Michigan; and
| | - Rasanjeet Singh
- 3Wayne State University School of Medicine, Detroit, Michigan; and
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Schreglmann SR, Krauss JK, Chang JW, Bhatia KP, Kägi G. Functional lesional neurosurgery for tremor: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2018; 89:717-726. [PMID: 29326290 DOI: 10.1136/jnnp-2017-316302] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/20/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND This work evaluates the consistency, effect size and incidence of persistent side effects of lesional neurosurgical interventions in the treatment of tremor due to Parkinson's disease (PD), essential tremor (ET), multiple sclerosis (MS) and midbrain lesions. METHODS Systematic review and meta-analysis according to PRISMA-P guidelines. Random effects meta-analysis of standardised mean difference based on a peer-reviewed protocol (PROSPERO no. CRD42016048049). RESULTS From 1249 abstracts screened, 86 peer-reviewed studies reporting 102 cohorts homogeneous for tremor aetiology, surgical target and technique were included.Effect on PD tremor was better when targeted at the ventral intermediate nucleus (V.im.) by radiofrequency ablation (RF) (Hedge's g: -4.15;) over V.im. by Gamma Knife (GK) (-2.2), subthalamic nucleus (STN) by RF (-1.12) and globus pallidus internus (GPi) by RF (-0.89). For ET MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract (CTT) (-2.35) and V.im. (-2.08) showed similar mean tremor reductions to V.im. ablation by RF (-2.42) or GK (-2.13). In MS V.im. ablation by GK (-1.96) and RF (-1.63) were similarly effective.Mean rates of persistent side effects after unilateral lesions in PD were 12.8% (RF V.im.), 13.6% (RF STN), 9.2% (RF GPi), 0.7% (GK V.im.) and 7.0% (MRIgFUS V.im.). For ET, rates were 9.3% (RF V.im.), 1.8% (GK V.im.), 18.7% (MRIgFUS V.im.) and 0.0% (MRIgFUS CTT), for MS 37.7% (RF V.im.) and for rubral tremor 30.3% (RF V.im.). CONCLUSION This meta-analysis quantifies safety, consistency and efficacy of lesional neurosurgical interventions for tremor by target, technique and aetiology.
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Affiliation(s)
- Sebastian R Schreglmann
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Schreglmann SR, Krauss JK, Chang JW, Martin E, Werner B, Bauer R, Hägele-Link S, Bhatia KP, Kägi G. Functional lesional neurosurgery for tremor: back to the future? J Neurol Neurosurg Psychiatry 2018; 89:727-735. [PMID: 29269505 DOI: 10.1136/jnnp-2017-316301] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/18/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
Abstract
For nearly a century, functional neurosurgery has been applied in the treatment of tremor. While deep brain stimulation has been in the focus of academic interest in recent years, the establishment of incisionless technology, such as MRI-guided high-intensity focused ultrasound, has again stirred interest in lesional approaches.In this article, we will discuss the historical development of surgical technique and targets, as well as the technological state-of-the-art of conventional and incisionless interventions for tremor due to Parkinson's disease, essential and dystonic tremor and tremor related to multiple sclerosis (MS) and midbrain lesions. We will also summarise technique-inherent advantages of each technology and compare their lesion characteristics. From this, we identify gaps in the current literature and derive future directions for functional lesional neurosurgery, in particularly potential trial designs, alternative targets and the unsolved problem of bilateral lesional treatment. The results of a systematic review and meta-analysis of the consistency, efficacy and side effect rate of lesional treatments for tremor are presented separately alongside this article.
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Affiliation(s)
- Sebastian R Schreglmann
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ernst Martin
- Center for Focused Ultrasound, University of Zurich, Children's Hospital Zurich, Zurich, Switzerland
| | - Beat Werner
- Center for Focused Ultrasound, University of Zurich, Children's Hospital Zurich, Zurich, Switzerland
| | - Ronald Bauer
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefan Hägele-Link
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, UCL, London, UK
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Tuleasca C, Najdenovska E, Régis J, Witjas T, Girard N, Champoudry J, Faouzi M, Thiran JP, Cuadra MB, Levivier M, Van De Ville D. Ventrolateral Motor Thalamus Abnormal Connectivity in Essential Tremor Before and After Thalamotomy: A Resting-State Functional Magnetic Resonance Imaging Study. World Neurosurg 2018; 113:e453-e464. [DOI: 10.1016/j.wneu.2018.02.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 01/30/2023]
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Tuleasca C, Najdenovska E, Régis J, Witjas T, Girard N, Champoudry J, Faouzi M, Thiran JP, Bach Cuadra M, Levivier M, Van De Ville D. Pretherapeutic functional neuroimaging predicts tremor arrest after thalamotomy. Acta Neurol Scand 2018; 137:500-508. [PMID: 29315459 DOI: 10.1111/ane.12891] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Essential tremor (ET) represents the most common movement disorder. Drug-resistant ET can benefit from standard stereotactic procedures (deep brain stimulation or radiofrequency thalamotomy) or alternatively minimally invasive high-focused ultrasound or radiosurgery. All aim at same target, thalamic ventro-intermediate nucleus (Vim). METHODS The study included a cohort of 17 consecutive patients, with ET, treated only with left unilateral stereotactic radiosurgical thalamotomy (SRS-T) between September 2014 and August 2015. The mean time to tremor improvement was 3.32 months (SD 2.7, 0.5-10). Neuroimaging data were collected at baseline (n = 17). Standard tremor scores, including activities of daily living (ADL) and tremor score on treated hand (TSTH), were completed pretherapeutically and 1 year later. We further correlate these scores with baseline inter-connectivity in twenty major large-scale brain networks. RESULTS We report as predictive three networks, with the interconnected statistically significant clusters: primary motor cortex interconnected with inferior olivary nucleus, bilateral thalamus interconnected with motor cerebellum lobule V2 (ADL), and anterior default-mode network interconnected with Brodmann area 103 (TSTH). For all, more positive pretherapeutic interconnectivity correlated with higher drop in points on the respective scores. Age, disease duration, or time-to-response after SRS-T were not statistically correlated with pretherapeutic brain connectivity measures (P > .05). The same applied to pretherapeutic tremor scores, after using the same methodology described above. CONCLUSIONS Our findings have clinical implications for predicting clinical response after SRS-T. Here, using pretherapeutic magnetic resonance imaging and data processing without prior hypothesis, we show that pretherapeutic network(s) interconnectivity strength predicts tremor arrest in drug-naïve ET, following stereotactic radiosurgical thalamotomy.
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Affiliation(s)
- C. Tuleasca
- Neurosurgery Service and Gamma Knife Center; Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
- Medical Image Analysis Laboratory (MIAL) and Department of Radiology-Center of Biomedical Imaging (CIBM); Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
- Signal Processing Laboratory (LTS 5); Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
- Faculty of Biology and Medicine; University of Lausanne; Lausanne Switzerland
| | - E. Najdenovska
- Medical Image Analysis Laboratory (MIAL) and Department of Radiology-Center of Biomedical Imaging (CIBM); Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - J. Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit; CHU Timone; Marseille France
| | - T. Witjas
- Neurology Department; CHU Timone; Marseille France
| | - N. Girard
- AMU, CRMBM UMR CNRS 7339; Faculté de Médecine et APHM; Department of Diagnostic and Interventionnal Neuroradiology; Hopital Timone; Marseille France
| | - J. Champoudry
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit; CHU Timone; Marseille France
| | - M. Faouzi
- Center for Clinical Epidemiology; Institute of Social and Preventive Medicine; Lausanne Switzerland
| | - J.-P. Thiran
- Signal Processing Laboratory (LTS 5); Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
- Faculty of Biology and Medicine; University of Lausanne; Lausanne Switzerland
- Department of Radiology; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - M. Bach Cuadra
- Medical Image Analysis Laboratory (MIAL) and Department of Radiology-Center of Biomedical Imaging (CIBM); Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
- Signal Processing Laboratory (LTS 5); Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
| | - M. Levivier
- Neurosurgery Service and Gamma Knife Center; Centre Hospitalier Universitaire Vaudois (CHUV); Lausanne Switzerland
- Faculty of Biology and Medicine; University of Lausanne; Lausanne Switzerland
| | - D. Van De Ville
- Faculty of Medicine; University of Geneva; Geneva Switzerland
- Medical Image Processing Laboratory; Ecole Polytechnique Fédérale de Lausanne (EPFL); Lausanne Switzerland
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Daneault JF. Could Wearable and Mobile Technology Improve the Management of Essential Tremor? Front Neurol 2018; 9:257. [PMID: 29725318 PMCID: PMC5916972 DOI: 10.3389/fneur.2018.00257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Individuals exhibit postural and kinetic tremor that worsens over time and patients may also exhibit other motor and non-motor symptoms. While millions of people are affected by this disorder worldwide, several barriers impede an optimal clinical management of symptoms. In this paper, we discuss the impact of ET on patients and review major issues to the optimal management of ET; from the side-effects and limited efficacy of current medical treatments to the limited number of people who seek treatment for their tremor. Then, we propose seven different areas within which mobile and wearable technology may improve the clinical management of ET and review the current state of research in these areas.
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Affiliation(s)
- Jean-Francois Daneault
- Motor Behavior Laboratory, Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers, The State University of New Jersey, Newark, NJ, United States
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46
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The Role of Stereotactic Ablative Radiotherapy in Oncological and Non-Oncological Clinical Settings: Highlights from the 7th Meeting of AIRO – Young Members Working Group (AIRO Giovani). TUMORI JOURNAL 2018. [DOI: 10.1177/1778.19280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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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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Clinical response to Vim's thalamic stereotactic radiosurgery for essential tremor is associated with distinctive functional connectivity patterns. Acta Neurochir (Wien) 2018; 160:611-624. [PMID: 29335882 DOI: 10.1007/s00701-017-3456-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Essential tremor (ET) is the most common movement disorder. Drug-resistant ET can benefit from standard surgical stereotactic procedures (deep brain stimulation, thalamotomy) or minimally invasive high-intensity focused ultrasound (HIFU) or stereotactic radiosurgical thalamotomy (SRS-T). Resting-state fMRI (rs-fMRI) is a non-invasive imaging method acquired in absence of a task. We examined whether rs-fMRI correlates with tremor score on the treated hand (TSTH) improvement 1 year after SRS-T. METHODS We included 17 consecutive patients treated with left unilateral SRS-T in Marseille, France. Tremor score evaluation and rs-fMRI were acquired at baseline and 1 year after SRS-T. Resting-state data (34 scans) were analyzed without a priori hypothesis, in Lausanne, Switzerland. Based on degree of improvement in TSTH, to consider SRS-T at least as effective as medication, we separated two groups: 1, ≤ 50% (n = 6, 35.3%); 2, > 50% (n = 11, 64.7%). They did not differ statistically by age (p = 0.86), duration of symptoms (p = 0.41), or lesion volume at 1 year (p = 0.06). RESULTS We report TSTH improvement correlated with interconnectivity strength between salience network with the left claustrum and putamen, as well as between bilateral motor cortices, frontal eye fields and left cerebellum lobule VI with right visual association area (the former also with lesion volume). Longitudinal changes showed additional associations in interconnectivity strength between right dorsal attention network with ventro-lateral prefrontal cortex and a reminiscent salience network with fusiform gyrus. CONCLUSIONS Brain connectivity measured by resting-state fMRI relates to clinical response after SRS-T. Relevant networks are visual, motor, and attention. Interconnectivity between visual and motor areas is a novel finding, revealing implication in movement sensory guidance.
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Right Brodmann area 18 predicts tremor arrest after Vim radiosurgery: a voxel-based morphometry study. Acta Neurochir (Wien) 2018; 160:603-609. [PMID: 29128955 DOI: 10.1007/s00701-017-3391-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Drug-resistant essential tremor (ET) can benefit from open standard stereotactic procedures, such as deep-brain stimulation or radiofrequency thalamotomy. Non-surgical candidates can be offered either high-focused ultrasound (HIFU) or radiosurgery (RS). All procedures aim to target the same thalamic site, the ventro-intermediate nucleus (e.g., Vim). The mechanisms by which tremor stops after Vim RS or HIFU remain unknown. We used voxel-based morphometry (VBM) on pretherapeutic neuroimaging data and assessed which anatomical site would best correlate with tremor arrest 1 year after Vim RS. METHODS Fifty-two patients (30 male, 22 female; mean age 71.6 years, range 49-82) with right-sided ET benefited from left unilateral Vim RS in Marseille, France. Targeting was performed in a uniform manner, using 130 Gy and a single 4-mm collimator. Neurological (pretherapeutic and 1 year after) and neuroimaging (baseline) assessments were completed. Tremor score on the treated hand (TSTH) at 1 year after Vim RS was included in a statistical parametric mapping analysis of variance (ANOVA) model as a continuous variable with pretherapeutic neuroimaging data. Pretherapeutic gray matter density (GMD) was further correlated with TSTH improvement. No a priori hypothesis was used in the statistical model. RESULTS The only statistically significant region was right Brodmann area (BA) 18 (visual association area V2, p = 0.05, cluster size Kc = 71). Higher baseline GMD correlated with better TSTH improvement at 1 year after Vim RS (Spearman's rank correlation coefficient = 0.002). CONCLUSIONS Routine baseline structural neuroimaging predicts TSTH improvement 1 year after Vim RS. The relevant anatomical area is the right visual association cortex (BA 18, V2). The question whether visual areas should be included in the targeting remains open.
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Martínez-Moreno NE, Sahgal A, De Salles A, Hayashi M, Levivier M, Ma L, Paddick I, Régis J, Ryu S, Slotman BJ, Martínez-Álvarez R. Stereotactic radiosurgery for tremor: systematic review. J Neurosurg 2018; 130:589-600. [PMID: 29473775 DOI: 10.3171/2017.8.jns17749] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/15/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this systematic review is to offer an objective summary of the published literature relating to stereotactic radiosurgery (SRS) for tremor and consensus guideline recommendations. METHODS This systematic review was performed up to December 2016. Article selection was performed by searching the MEDLINE (PubMed) and EMBASE electronic bibliographic databases. The following key words were used: "radiosurgery" and "tremor" or "Parkinson's disease" or "multiple sclerosis" or "essential tremor" or "thalamotomy" or "pallidotomy." The search strategy was not limited by study design but only included key words in the English language, so at least the abstract had to be in English. RESULTS A total of 34 full-text articles were included in the analysis. Three studies were prospective studies, 1 was a retrospective comparative study, and the remaining 30 were retrospective studies. The one retrospective comparative study evaluating deep brain stimulation (DBS), radiofrequency thermocoagulation (RFT), and SRS reported similar tremor control rates, more permanent complications after DBS and RFT, more recurrence after RFT, and a longer latency period to clinical response with SRS. Similar tremor reduction rates in most of the reports were observed with SRS thalamotomy (mean 88%). Clinical complications were rare and usually not permanent (range 0%-100%, mean 17%, median 2%). Follow-up in general was too short to confirm long-term results. CONCLUSIONS SRS to the unilateral thalamic ventral intermediate nucleus, with a dose of 130-150 Gy, is a well-tolerated and effective treatment for reducing medically refractory tremor, and one that is recommended by the International Stereotactic Radiosurgery Society.
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Affiliation(s)
- Nuria E Martínez-Moreno
- 1Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - Arjun Sahgal
- 2Department of Radiation Oncology, University of Toronto, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Antonio De Salles
- 3Department of Neurosurgery, University of California, Los Angeles, California
| | - Motohiro Hayashi
- 4Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Marc Levivier
- 5Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Lijun Ma
- 6Division of Physics, Department of Radiation Oncology, University of California, San Francisco, California
| | - Ian Paddick
- 7Division of Physics, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jean Régis
- 8Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Sam Ryu
- 9Department of Radiation Oncology, Stony Brook University, Stony Brook, New York; and
| | - Ben J Slotman
- 10Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Martínez-Álvarez
- 1Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
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