HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.
Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain.
J Neurol Neurosurg Psychiatry. 2021 Sep;92(9):927-931. doi: 10.1136/jnnp-2020-325278. Epub 2021 Apr 27.
Unilateral magnetic resonance-guided focused ultrasound (FUS) thalamotomy is efficacious for the treatment of medically refractory essential tremor (ET). Viability of bilateral FUS ablation is unexplored.
Patients diagnosed with medically refractory ET and previously treated with unilateral FUS thalamotomy at least 5 months before underwent bilateral treatment. The timepoints were baseline (before first thalamotomy) and FUS1 and FUS2 (4 weeks before and 6 months after second thalamotomy, respectively). The primary endpoint was safety. Efficacy was assessed through the Clinical Rating Scale for Tremor (CRST), which includes subscales for tremor examination (part A), task performance (part B) and tremor-related disability (part C).
Nine patients were treated. No permanent adverse events were registered. Six patients presented mild gait instability and one dysarthria, all resolving within the first few weeks. Three patients reported perioral hypoesthesia, resolving in one case. Total CRST score improved by 71% from baseline to FUS2 (from 52.3±12 to 15.5±9.4, p<0.001), conveying a 67% reduction in bilateral upper limb A+B (from 32.3±7.8 to 10.8±7.3, p=0.001). Part C decreased by 81% (from 16.4±3.6 to 3.1±2.9, p<0.001). Reduction in head and voice tremor was 66% (from 1.2±0.44 to 0.4±0.54, p=0.01) and 45% (from 1.8±1.1 to 1±0.8, p=0.02), respectively.
Bilateral staged FUS thalamotomy for ET is feasible and might be safe and effective. Voice and head tremor might also improve. A controlled study is warranted.
单侧磁共振引导聚焦超声（FUS）丘脑切开术治疗药物难治性原发性震颤（ET）有效。双侧 FUS 消融的可行性尚未得到探索。
至少在 5 个月前接受单侧 FUS 丘脑切开术治疗的药物难治性 ET 患者接受了双侧治疗。时间点为基线（第一次丘脑切开术之前）和 FUS1 和 FUS2（分别为第二次丘脑切开术前 4 周和 6 个月）。主要终点是安全性。通过震颤临床评定量表（CRST）评估疗效，该量表包括震颤检查（A 部分）、任务表现（B 部分）和震颤相关残疾（C 部分）的子量表。
9 例患者接受了治疗。无永久性不良事件发生。6 例患者出现轻度步态不稳和 1 例构音障碍，均在数周内缓解。3 例患者报告口周感觉减退，1 例缓解。从基线到 FUS2，总 CRST 评分改善了 71%（从 52.3±12 到 15.5±9.4，p<0.001），双侧上肢 A+B 评分降低了 67%（从 32.3±7.8 到 10.8±7.3，p=0.001）。C 部分下降了 81%（从 16.4±3.6 到 3.1±2.9，p<0.001）。头部和声音震颤减少了 66%（从 1.2±0.44 到 0.4±0.54，p=0.01）和 45%（从 1.8±1.1 到 1±0.8，p=0.02）。
双侧分期 FUS 丘脑切开术治疗 ET 是可行的，可能安全有效。声音和头部震颤也可能改善。需要进行对照研究。
