Rohani Mohammad, Fasano Alfonso
Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran.
Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
Tremor Other Hyperkinet Mov (N Y). 2017 May 5;7:462. doi: 10.7916/D8Z89JN1. eCollection 2017.
While there is no breakthrough progress in the medical treatment of essential tremor (ET), in the past decades several remarkable achievements happened in the surgical field, such as radiofrequency thalamotomy, thalamic deep brain stimulation, and gamma knife thalamotomy. The most recent advance in this area is magnetic resonance-guided focused ultrasound (MRgFUS).
The purpose of this review is to discuss the new developments and trials of MRgFUS in the treatment of ET and other tremor disorders.
MRgFUS is an incisionless surgery performed without anesthesia and ionizing radiation (no risk of cumulative dose and delayed side effects). Studies have shown the safety and effectiveness of unilateral MRgFUS-thalamotomy in the treatment of ET. It has been successfully used in a few patients with Parkinson's disease-related tremor, and in fewer patients with fragile X-associated tremor/ataxia syndrome. The safety and long-term effects of the procedure are still unclear, as temporary and permanent adverse events have been reported as well as recurrence of tremor.
MRgFUS is a promising new surgical approach with a number of unknowns and unsolved issues. It represents a valuable option particularly for patients who refused or could not be candidates for other procedures, deep brain stimulation in particular.
虽然特发性震颤（ET）的药物治疗尚无突破性进展，但在过去几十年中，外科领域取得了一些显著成就，如射频丘脑切开术、丘脑深部脑刺激术和伽玛刀丘脑切开术。该领域的最新进展是磁共振引导聚焦超声（MRgFUS）。
本综述的目的是讨论MRgFUS在治疗ET和其他震颤疾病方面的新进展和试验。
MRgFUS是一种无需麻醉和电离辐射的无创手术（无累积剂量风险和延迟副作用）。研究表明，单侧MRgFUS丘脑切开术治疗ET具有安全性和有效性。它已成功应用于少数帕金森病相关性震颤患者，以及更少的脆性X相关震颤/共济失调综合征患者。该手术的安全性和长期效果仍不明确，因为已报告了暂时和永久性不良事件以及震颤复发情况。
MRgFUS是一种有前景的新手术方法，但存在许多未知和未解决的问题。它是一种有价值的选择，特别是对于那些拒绝或不适合其他手术（尤其是深部脑刺激术）的患者。
