Department of Neurology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland.
Warsaw Gamma Knife Centre, Warsaw, Poland.
Neurol Neurochir Pol. 2024;58(3):283-291. doi: 10.5603/pjnns.98157. Epub 2024 May 14.
Unilateral gamma knife thalamotomy (GKT) is a treatment option for pharmacoresistant tremor of various aetiologies. There have been to date no randomised controlled trials performed to assess its safety and efficacy. Our aim was to summarise a two-year multimodal observation of patients with tremor caused by Parkinson's Disease (PD) or essential tremor (ET).
23 patients with PD (n = 12) or ET (n = 11) were included. They underwent assessments before, V0 (n = 23), and 12 months, V12 (n = 23), and 24 months, V24 (n = 15), after unilateral GKT. Patients were assessed with psychological tests and acoustic voice analysis. Tremor assessment was performed with a digitising table using the Fahn-Tolosa-Marin rating scale (FTMRS). The Unified Parkinson's Disease rating scale part III (UPDRS-III) was also used in the PD group. Gait and balance was assessed using clinical tests, stabilometric platform, and treadmill.
No side effects were observed in a two-year follow-up. There was no notable deterioration observed in the patients' psychological evaluation, speech, or assessment of gait and balance. The scores were significantly lower (p = 0.01) in parts A and B of FTMRS one year after GKT. In post hoc analysis, the scores did not differ significantly between V0 and V24. In FTMRS part C (activities of daily living), no significant change was observed. There was no significant difference in total UPDRS part III score or in score of UPDRS part III domains 3 and 4 ('tremor at rest' and 'action and postural tremor of hands') between measurements.
UGKT may be a safe treatment modality if performed in an experienced centre. Tremor reduction may diminish over time, and UGKT did not lead to cognitive, gait or speech deterioration in a long-term observation.
单侧伽玛刀丘脑切开术（GKT）是治疗各种病因药物难治性震颤的一种选择。迄今为止，尚未进行随机对照试验来评估其安全性和有效性。我们的目的是总结 2 年来对帕金森病（PD）或特发性震颤（ET）震颤患者的多模态观察结果。
共纳入 23 例 PD（n=12）或 ET（n=11）患者。他们在单侧 GKT 前（V0，n=23）、术后 12 个月（V12，n=23）和 24 个月（V24，n=15）进行了评估。患者接受了心理测试和声学语音分析。震颤评估采用数字化表，采用 Fahn-Tolosa-Marin 评定量表（FTMRS）。PD 组还采用了统一帕金森病评定量表第 III 部分（UPDRS-III）。步态和平衡采用临床测试、平衡台和跑步机进行评估。
在 2 年的随访中未观察到任何副作用。患者的心理评估、言语或步态和平衡评估未见明显恶化。在 GKT 后 1 年，FTMRS 量表的 A 部分和 B 部分评分明显降低（p=0.01）。事后分析显示，V0 与 V24 之间的评分无显著差异。在 FTMRS 量表的 C 部分（日常生活活动）中，未观察到明显变化。在总 UPDRS 量表第 III 部分评分或 UPDRS 量表第 III 部分 3 个和 4 个领域（“静息时震颤”和“手部动作性和姿势性震颤”）评分方面，无显著差异。
如果在有经验的中心进行，UGKT 可能是一种安全的治疗方式。震颤缓解可能随时间而减弱，在长期观察中，UGKT 不会导致认知、步态或言语恶化。
