Kyle Kain, Maller Jerome, Barnett Yael, Jonker Benjamin, Barnett Michael, D'Souza Arkiev, Calamante Fernando, Maamary Joel, Peters James, Wang Chenyu, Tisch Stephen
Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia.
Front Neurol. 2023 Apr 25;14:1129430. doi: 10.3389/fneur.2023.1129430. eCollection 2023.
Magnetic resonance-guided focussed ultrasound (MRgFUS) is an incisionless ablative procedure, widely used for treatment of Parkinsonian and Essential Tremor (ET). Enhanced understanding of the patient- and treatment-specific factors that influence sustained long-term tremor suppression could help clinicians achieve superior outcomes improved patient screening and treatment strategy.
We retrospectively analysed data from 31 subjects with ET, treated with MRgFUS at a single centre. Tremor severity was assessed with parts A, B and C of the Clinical Rating Scale for Tremor (CRST) as well as the combined CRST. Tremor in the dominant and non-dominant hand was assessed with Hand Tremor Scores (HTS), derived from the CRST. Pre- and post-treatment imaging data were analysed to determine ablation volume overlap with automated thalamic segmentations, and the dentatorubrothalamic tract (DRTT) and compared with percentage change in CRST and HTS following treatment.
Tremor symptoms were significantly reduced following treatment. Combined pre-treatment CRST (mean: 60.7 ± 17.3) and HTS (mean: 19.2 ± 5.7) improved by an average of 45.5 and 62.6%, respectively. Percentage change in CRST was found to be significantly negatively associated with age (β = -0.375, = 0.015), and SDR standard deviation (SDR; β = -0.324, = 0.006), and positively associated with ablation overlap with the posterior DRTT (β = 0.535, < 0.001). Percentage HTS improvement in the dominant hand decreased significantly with older age (β = -0.576, < 0.01).
Our results suggest that increased lesioning of the posterior region of the DRTT could result in greater improvements in combined CRST and non-dominant hand HTS, and that subjects with lower SDR standard deviation tended to experience greater improvement in combined CRST.
磁共振引导聚焦超声（MRgFUS）是一种无创消融手术，广泛用于治疗帕金森病和特发性震颤（ET）。深入了解影响长期震颤抑制的患者和治疗特定因素，有助于临床医生取得更好的治疗效果，改进患者筛选和治疗策略。
我们回顾性分析了在单一中心接受MRgFUS治疗的31例ET患者的数据。使用震颤临床评分量表（CRST）的A、B和C部分以及综合CRST评估震颤严重程度。使用源自CRST的手部震颤评分（HTS）评估优势手和非优势手的震颤。分析治疗前后的影像数据，以确定消融体积与自动丘脑分割以及齿状红核丘脑束（DRTT）的重叠情况，并与治疗后CRST和HTS的百分比变化进行比较。
治疗后震颤症状明显减轻。治疗前综合CRST（平均：60.7±17.3）和HTS（平均：19.2±5.7）分别平均改善了45.5%和62.6%。发现CRST的百分比变化与年龄（β=-0.375，P=0.015）和SDR标准差（SDR；β=-0.324，P=0.006）显著负相关，与消融与后DRTT的重叠正相关（β=0.535，P<0.001）。优势手HTS改善的百分比随年龄增长显著降低（β=-0.576，P<0.01）。
我们的结果表明，增加DRTT后部区域的损伤可能会使综合CRST和非优势手HTS有更大改善，并且SDR标准差较低的受试者在综合CRST方面往往有更大改善。
