Schreglmann Sebastian R, Bauer Ronald, Hägele-Link Stefan, Bhatia Kailash P, Natchev Parashkev, Wegener Nikolas, Lebeda Anita, Werner Beat, Martin Ernst, Kägi Georg
From the Departments of Neurology (S.R.S., S.H.-L., N.W., A.L., G.K.) and Neurosurgery (R.B.), Kantonsspital St. Gallen, Switzerland; Sobell Department of Motor Neuroscience and Movement Disorders (S.R.S., K.P.B.), University College London, Institute of Neurology, UK; Institute of Neurology (P.N.), Queen Square, London, UK; and Center for Focused Ultrasound (B.W., E.M.), University of Zurich, Children's Hospital Zurich, Switzerland.
Neurology. 2017 Apr 4;88(14):1329-1333. doi: 10.1212/WNL.0000000000003795. Epub 2017 Mar 8.
To report results of a prospective trial of unilateral transcranial MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract in essential tremor (ET).
This was a prospective, uncontrolled, single-center interventional study. Patients with ET fulfilling criteria for interventional therapy received unilateral ablation of the cerebellothalamic tract (CTT) by MRIgFUS. Motor symptoms, manual dexterity, cognition, and quality of life were assessed before intervention and at 48 hours and 1, 3, and 6 months after intervention. Rating of standardized video recordings was blinded for evaluation time points. Primary outcome was the change in unilateral hand tremor score of the treated hand.
Six patients received MRIgFUS ablation of the CTT contralateral to the treated hand. Repeated-measures comparison determined a statistically significant 83% reduction (before vs 6 months after intervention mean ± SD; absolute reduction; 95% confidence interval) in the unilateral treated hand subscore (14.3 ± 4.9 vs 2.5 ± 2.6; 11.8; 8.4-15.2; < 0.001), while quality of life improved by 52% (50.5 ± 19.4 vs 24.8 ± 11.4; 25.7; 3.5-47.28; = 0.046). Measures for manual dexterity, attention and coordination, and overall cognition were unchanged. Transient side effects (n = 3) were ipsilateral hand clumsiness and mild gait instability for up to 3 months.
Unilateral MRIgFUS lesioning of the CTT was highly efficacious in reducing contralateral hand tremor in ET without affecting fine motor function and dexterity over 6 months of follow-up. Adverse effects were mild and transient.
This study provides Class IV evidence that for patients with ET, transcranial MRIgFUS ablation of the cerebellothalamic tract improves tremor.
报告一项关于原发性震颤（ET）患者单侧经颅磁共振成像引导聚焦超声（MRIgFUS）消融小脑丘脑束的前瞻性试验结果。
这是一项前瞻性、非对照、单中心干预性研究。符合干预治疗标准的ET患者接受MRIgFUS单侧消融小脑丘脑束（CTT）。在干预前以及干预后48小时、1个月、3个月和6个月评估运动症状、手部灵活性、认知和生活质量。对标准化视频记录的评分在评估时间点上是盲法的。主要结局是治疗侧手部单侧手震颤评分的变化。
6例患者接受了与治疗手对侧的CTT的MRIgFUS消融。重复测量比较确定，治疗侧手部单侧子评分在干预前与干预后6个月之间有统计学显著的83%降低（均值±标准差；绝对降低值；95%置信区间）（14.3±4.9 vs 2.5±2.6；11.8；8.4 - 15.2；<0.001），而生活质量提高了52%（50.5±19.4 vs 24.8±11.4；25.7；3.5 - 47.28；=0.046）。手部灵活性、注意力和协调性以及整体认知的测量指标未发生变化。短暂的副作用（n = 3）为同侧手部笨拙和轻度步态不稳，持续长达3个月。
在6个月的随访中，单侧MRIgFUS损伤CTT在减轻ET患者对侧手部震颤方面非常有效，且不影响精细运动功能和灵活性。不良反应轻微且短暂。
本研究提供了IV级证据，即对于ET患者，经颅MRIgFUS消融小脑丘脑束可改善震颤。
