Campins-Romeu Marina, Conde-Sardón Rebeca, Sastre-Bataller Isabel, Baviera-Muñoz Raquel, Losada-López Mireya, Morata-Martínez Carlos, Ibáñez-Juliá María José, León-Guijarro José Luís, Pérez-García Julia, Raga-Rodríguez Luis, Lozano Andrés M, Gutiérrez-Martín Antonio, Martínez-Torres Irene
Movement Disorders Unit, Department of Neurology, University and Polytechnic La Fe Hospital, Valencia 46026, Spain.
Unit of Functional Neurosurgery, Department of Neurosurgery, University and Polytechnic La Fe Hospital, Valencia 46026, Spain.
Brain Commun. 2025 May 2;7(3):fcaf168. doi: 10.1093/braincomms/fcaf168. eCollection 2025.
Essential Tremor is a common movement disorder characterized by postural and kinetic tremor, primarily affecting the upper limbs, head and voice. For patients who fail medical therapy, neurosurgical interventions such as thalamotomy have been explored. This study evaluates the efficacy and safety of bilateral staged Magnetic Resonance Imaging-guided High-Intensity Focused Ultrasound thalamotomy for the treatment of medication-refractory Essential Tremor. From January 2022 to January 2024, 20 patients who had previously undergone successful unilateral focused ultrasound thalamotomy were enrolled. The primary outcome was the change in tremor severity, using the Clinical Rating Scale for Tremor at 6 months post-second side thalamotomy. Secondary outcomes included functional disability, quality of life and adverse events, particularly balance and gait impairments. Results demonstrated significant tremor reduction, with a 59.98% decrease in Clinical Rating Scale for Tremor A + B score from baseline to 6 months after the second thalamotomy. Quality of life also improved markedly, with an 84.91% reduction in disability and significant enhancement in physical and psychosocial aspects of quality of life. Adverse events were predominantly mild; with subjective gait instability and paresthaesia being the most common. Notably, no cases of severe ataxia or cognitive impairment were observed. Bilateral staged Magnetic Resonance Imaging-guided High-Intensity Focused Ultrasound thalamotomy is an effective and safe treatment for medication-refractory Essential Tremor, providing substantial tremor relief and improved quality of life with manageable side effects. These findings support its use as an alternative to more invasive neurosurgical procedures, especially in carefully selected patients.
特发性震颤是一种常见的运动障碍，其特征为姿势性和动作性震颤，主要影响上肢、头部和声音。对于药物治疗无效的患者，已探索了丘脑切开术等神经外科干预措施。本研究评估双侧分期磁共振成像引导下高强度聚焦超声丘脑切开术治疗药物难治性特发性震颤的疗效和安全性。从2022年1月至2024年1月，招募了20名先前已成功接受单侧聚焦超声丘脑切开术的患者。主要结局是在第二次丘脑切开术后6个月使用震颤临床评分量表评估的震颤严重程度变化。次要结局包括功能残疾、生活质量和不良事件，尤其是平衡和步态障碍。结果显示震颤明显减轻，从基线到第二次丘脑切开术后6个月，震颤临床评分量表A + B评分下降了59.98%。生活质量也显著改善，残疾率降低了84.91%，生活质量的身体和心理社会方面有显著提高。不良事件主要为轻度；主观步态不稳和感觉异常最为常见。值得注意的是，未观察到严重共济失调或认知障碍病例。双侧分期磁共振成像引导下高强度聚焦超声丘脑切开术是治疗药物难治性特发性震颤的一种有效且安全的方法，可显著减轻震颤并改善生活质量，且副作用可控。这些发现支持将其用作更具侵入性的神经外科手术的替代方法，尤其是在经过精心挑选的患者中。
