Faculty of Medicine and Health Translational Research Collective, The University of Sydney, Camperdown, New South Wales, Australia.
Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.
Mov Disord Clin Pract. 2024 May;11(5):504-514. doi: 10.1002/mdc3.14005. Epub 2024 Mar 12.
Magnetic resonance-guided focused ultrasound (MRgFUS) for treatment of essential tremor (ET) traditionally targets the ventral intermediate (Vim) nucleus. Recent strategies include a secondary lesion to the posterior subthalamic area (PSA).
The aim was to compare lesion characteristics, tremor improvement, and adverse events (AE) between patients in whom satisfactory tremor suppression was achieved with lesioning of the Vim alone and patients who required additional lesioning of the PSA.
Retrospective analysis of data collected from ET patients treated with MRgFUS at St Vincent's Hospital Sydney was performed. Clinical Rating Scale for Tremor (CRST), hand tremor score (HTS), and Quality of Life in Essential Tremor Questionnaire (QUEST) were collected pre- and posttreatment in addition to the prevalence of AEs. The lesion coordinates and overlap with the dentatorubrothalamic tract (DRTT) were evaluated using magnetic resonance imaging.
Twenty-one patients were treated in Vim only, and 14 were treated with dual Vim-PSA lesions. Clinical data were available for 29 of the 35 patients (19 single target and 10 dual target). At follow-up (mean: 18.80 months) HTS, CRST, and QUEST in single-target patients improved by 57.97% (P < 0.001), 36.71% (P < 0.001), and 58.26% (P < 0.001), whereas dual-target patients improved by 68.34% (P < 0.001), 35.37% (P < 0.003), and 46.97% (P < 0.005), respectively. The Vim lesion of dual-target patients was further anterior relative to the posterior commissure (PC) (7.84 mm), compared with single-target patients (6.92 mm), with less DRTT involvement (14.85% vs. 23.21%). Dual-target patients exhibited a greater proportion of patients with acute motor AEs (100% vs. 58%); however, motor AE prevalence was similar in both groups at long-term follow-up (33% vs. 38%).
Posterior placement of lesions targeting the Vim may confer greater tremor suppression. The addition of a PSA lesion, in patients with inadequate tremor control despite Vim lesioning, had a trend toward better long-term tremor suppression; however, this approach was associated with greater prevalence of gait disturbance in the short term.
磁共振引导聚焦超声（MRgFUS）治疗原发性震颤（ET）传统上靶向腹中间核（Vim）。最近的策略包括对后丘脑下核（PSA）进行二次损伤。
旨在比较仅行 Vim 核毁损术即可获得满意震颤抑制的患者与需要行 PSA 额外毁损术的患者之间的病变特征、震颤改善和不良事件（AE）。
对在悉尼圣文森特医院接受 MRgFUS 治疗的 ET 患者的数据进行回顾性分析。除了 AE 的发生率外，还在治疗前和治疗后收集临床震颤评分量表（CRST）、手部震颤评分（HTS）和原发性震颤生活质量问卷（QUEST）。使用磁共振成像评估病变坐标和与齿状红核束（DRTT）的重叠。
21 例患者仅行 Vim 核治疗，14 例患者行 Vim-PSA 双重靶点治疗。35 例患者中有 29 例（19 例单靶点和 10 例双靶点）获得了临床数据。在随访（平均：18.80 个月）时，单靶点患者的 HTS、CRST 和 QUEST 分别改善了 57.97%（P<0.001）、36.71%（P<0.001）和 58.26%（P<0.001），而双靶点患者则分别改善了 68.34%（P<0.001）、35.37%（P<0.003）和 46.97%（P<0.005）。与单靶点患者（6.92mm）相比，双靶点患者的 Vim 病变相对于后连合（PC）更靠前（7.84mm），且 DRTT 受累程度更低（14.85%比 23.21%）。双靶点患者中急性运动性 AE 的比例更高（100%比 58%），但两组在长期随访中（33%比 38%）的运动性 AE 发生率相似。
靶向 Vim 的病变位置偏后可能会更好地抑制震颤。对于尽管进行了 Vim 核毁损术但震颤控制仍不理想的患者，增加 PSA 病变可能会使震颤得到更好的长期抑制；然而，这种方法在短期内与更常见的步态障碍有关。
