Fibrinogen is the key factor associated with tremor relief and recurrence after magnetic resonance-guided focused ultrasound thalamotomy.

INTRODUCTION

Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is safe and effective for tremor disorders such as essential tremor (ET), but whether preoperative serum profiles mediate tremor recurrence after treatment requires further investigation.

METHODS

We retrospectively analyzed the data of 59 ET patients who underwent unilateral MRgFUS thalamotomy during 2018-2020. Tremor severity was assessed off-medication using the Clinical Rating Scale for Tremor (CRST), with contralateral hand tremor measured via a derived CRST subscale. Short-term tremor relief was defined as ≥ 50 % reduction at 1-month postoperatively, and tremor recurrence was defined as a worsening by 25 % and at least 8 points within 12 months. Multivariate logistic regression analyses were performed to identify predictors of tremor relief and recurrence, and variables with  < 0.05 were used to construct nomograms for tremor relief and recurrence. Receiver operating characteristic curves, calibration analysis, and the Hosmer-Lemeshow test were conducted to evaluate the nomograms.

RESULTS

At 1-month after MRgFUS thalamotomy, hand tremor scores were decreased by > 50 % relative to the preoperative score in all patients and by > 75 % in 39 (66.10 %) patients. However, 9 (15.25 %) patients developed tremor recurrence within 12 months. Multivariate analysis showed that fibrinogen was independently linked to short-term tremor relief (odds ratio [OR]: 0.18) and long-term tremor recurrence (OR: 1.620). The nomograms for tremor relief and recurrence showed high performance (areas under the curve: 0.82 and 0.83, respectively); the Hosmer-Lemeshow test yielded values of 0.54 and 0.498, respectively. The calibration curves exhibited high consistency.

CONCLUSION

Serum fibrinogen is a key factor for tremor relief and recurrence in ET patients undergoing unilateral MRgFUS thalamotomy.