García-de Soto J, Pouso-Diz J M, Fernández-Pajarín G, Román-Pena P, Arán-Echabe E, Mosqueira A J, Blanco-Ulla M, Ares B, Sesar A
Hospital Clínico Universitario, Santiago de Compostela, España.
Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, España.
Rev Neurol. 2024 Jun 16;78(12):335-341. doi: 10.33588/rn.7812.2024104.
High intensity focal ultrasound (HIFU) thalamotomy is a novel treatment for refractory tremor. This study aims to compare the reduction in tremor intensity and adverse effects of treatment between patients younger and older than 70 years of age.
All the patients with refractory essential tremor treated with HIFU between March 2021 and March 2023 were included consecutively. Various demographic and clinical variables were analysed, including age and the items on the Clinical Rating Scale for Tremor (CRST). Cerebral vascular pathology was quantified using the Fazekas scale. Outcomes and adverse effects were compared between the patients aged 70 years or younger, and those older than 70 years.
Ninety patients were included, and 50 of them were over 70 years old. Prior to treatment, the CRST A + B score was 20.4 ± 5.7 among those under 70 years of age, and 23.3 ± 5.1 in those older (p = 0.013). At six months after treatment, the mean was 3.8 ± 5.1 and 4.8 ± 4.5, respectively (p = 0.314). We found no significant differences in the CRST C score (2.8 ± 4.1 and 3.5 ± 4.8, p = 0.442). There were also no significant differences between the patients with vascular pathology (Fazekas = 1) and those without (4.6 ± 7.3 and 4.3 ± 4, p = 0.832). There were no differences in the presence of adverse effects between the groups based on age and vascular pathology.
Contrary to traditional opinion, older patients do not have a poorer response or a higher rate of adverse effects after HIFU treatment.
高强度聚焦超声（HIFU）丘脑切开术是一种治疗难治性震颤的新方法。本研究旨在比较70岁及以下和70岁以上患者治疗后震颤强度的降低情况及不良反应。
连续纳入2021年3月至2023年3月期间接受HIFU治疗的所有难治性特发性震颤患者。分析了各种人口统计学和临床变量，包括年龄和震颤临床评分量表（CRST）中的项目。使用 Fazekas量表对脑血管病变进行量化。比较了70岁及以下患者和70岁以上患者的治疗效果及不良反应。
共纳入90例患者，其中50例年龄超过70岁。治疗前，70岁以下患者的CRST A + B评分为20.4±5.7，70岁以上患者为23.3±5.1（p = 0.013）。治疗后6个月，平均值分别为3.8±5.1和4.8±4.5（p = 0.314）。我们发现CRST C评分无显著差异（2.8±4.1和3.5±4.8，p = 0.442）。有血管病变（Fazekas = 1）的患者和无血管病变的患者之间也无显著差异（4.6±7.3和4.3±4，p = 0.832）。基于年龄和血管病变的组间不良反应发生率无差异。
与传统观点相反，老年患者在HIFU治疗后反应并不更差，不良反应发生率也不更高。
