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Ann. Neurol., Accepted manuscript online: 19 DEC 2017, DOI: 10.1002/ana.25126 A Prospective Trial of Magnetic Resonance guided Focused Ultrasound Thalamotomy for Essential Tremor: Results at the 2-year Follow-up

Jin Woo Chang MD, PhD^1,†,*, Chang Kyu Park MD^1,†, Nir Lipsman MD, PhD², Michael L. Schwartz MD², Pejman Ghanouni MD, PhD³, Jaimie M Henderson MD⁴, Ryder Gwinn MD⁵, Jennifer Witt MD⁶, Travis S. Tierney MD, PhD⁷, G. Rees Cosgrove MD⁸, Binit B. Shah MD⁹, Keiichi Abe MD¹⁰, Takaomi Taira MD, PhD¹⁰, Andres M. Lozano MD¹¹, Howard M. Eisenberg MD¹², Paul S. Fishman MD, PhD¹³ andW. Jeffrey Elias MD¹⁴¹Department of Neurosurgery Yonsei University College of Medicine, Seoul, South Korea

²Department of Neurosurgery Sunnybrook Health Sciences Centre, Toronto, Canada

³Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA

⁴Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA

⁵Department of Neurosurgery Swedish Neuroscience Institute, Seattle, USA

⁶Department of Neurosurgery Swedish Neuroscience Institute, Seattle, USA

⁷Department of Neurosurgery, University of Miami School of Medicine, Nicklaus Children's Hospital, Miami, USA

⁸Department of Neurosurgery, Brigham and Women's Hospital, Boston, USA

⁹Department of Neurology, University of Virginia Health Sciences Center, Charlottesville, USA

¹⁰Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan

¹¹Department of Neurosurgery, University of Toronto, Toronto, Canada

¹²Department of Neurosurgery, University of Maryland, Baltimore, USA

¹³Department of Neurology, University of Maryland, Baltimore, USA

¹⁴Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville, USA
^†These authors contributed equally to this work as co-first author.

^*Correspondence to: Prof. Jin Woo Chang, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea, 50 Yonseiro, Seodamungu, Seoul, 120-752, Korea

Abstract

Objective: Magnetic resonance guided focused ultrasound (MRgFUS) has recently been investigated as a new treatment modality for essential tremor (ET), but the durability of the procedure has not yet been evaluated. This study reports results at a 2- year follow-up after MRgFUS thalamotomy for ET.

Methods: A total of 76 patients with moderate-to-severe ET, who had not responded to at least two trials of medical therapy, were enrolled in the original randomized study of unilateral thalamotomy and evaluated using the clinical rating scale for tremor. Sixty-seven of the patients continued in the open-label extension phase of the study with monitoring for 2 years. Nine patients were excluded by two years, for example because of alternative therapy such as deep brain stimulation (n = 3) or inadequate thermal lesioning (n = 1). However, all patients in each follow-up period were analyzed.

Results: Mean hand tremor score at baseline (19.8±4.9, 76 patients) improved by 55% at 6 months (8.6±4.5, 75 patients). The improvement in tremor score from baseline was durable at 1 year (53%, 8.9±4.8, 70 patients) and at 2 years (56%, 8.8±5.0, 67 patients). Similarly, the disability score at baseline (16.4±4.5, 76 patients) improved by 64% at 6 months (5.4±4.7, 75 patients). This improvement was also sustained at 1 year (5.4±5.3, 70 patients) and at 2 years (6.5±5.0, 67 patients). Paresthesias and gait disturbances were the most common adverse effects at 1 year-each observed in 10 patients with an additional 5 patients experiencing neurological adverse effects. None of the adverse events worsened over the period of follow up and 2 of these resolved. There were no new delayed complications at 2 years.

Interpretation: Tremor suppression after MRgFUS thalamotomy for ET is stably maintained at 2 years. Latent or delayed complications do not develop after treatment. This article is protected by copyright. All rights reserved.

논문정보

형식Research article
게재일2017년 12월 (BRIC 등록일 2018-01-08)
연구진국내(교신)+국외 연구진
분야 의약학 > 응용의학

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