Magnetic resonance imaging–guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results

Author:

Cosgrove G. Rees1,Lipsman Nir2,Lozano Andres M.3,Chang Jin Woo4,Halpern Casey1,Ghanouni Pejman5,Eisenberg Howard2,Fishman Paul6,Taira Takaomi7,Schwartz Michael L.2,McDannold Nathan8,Hayes Michael9,Ro Susie10,Shah Binit11,Gwinn Ryder2,Santini Veronica E.9,Hynynen Kullervo12,Elias W. Jeff13

Affiliation:

1. Departments of Neurosurgery,

2. Departments of Neurosurgery and

3. Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Ontario, Canada;

4. Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea;

5. Radiology, Stanford University School of Medicine, Stanford, California;

6. Neurology, University of Maryland School of Medicine, Baltimore, Maryland;

7. Department of Neurosurgery, Tokyo Women’s Medical University, Tokyo, Japan;

8. Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;

9. Neurology, and

10. Neurology, Swedish Neuroscience Center, Seattle, Washington; and

11. Neurology, University of Virginia School of Medicine, Charlottesville, Virginia

12. Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada;

13. Departments of Neurological Surgery and

Abstract

OBJECTIVE The objective of this study was to evaluate, at 4 and 5 years posttreatment, the long-term safety and efficacy of unilateral MRI-guided focused ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor in a cohort of patients from a prospective, controlled, multicenter clinical trial. METHODS Outcomes per the Clinical Rating Scale for Tremor (CRST), including postural tremor scores (CRST Part A), combined hand tremor/motor scores (CRST Parts A and B), and functional disability scores (CRST Part C), were measured by a qualified neurologist. The Quality of Life in Essential Tremor Questionnaire (QUEST) was used to assess quality of life. CRST and QUEST scores at 48 and 60 months post-MRgFUS were compared to those at baseline to assess treatment efficacy and durability. All adverse events (AEs) were reported. RESULTS Forty-five and 40 patients completed the 4- and 5-year follow-ups, respectively. CRST scores for postural tremor (Part A) for the treated hand remained significantly improved by 73.3% and 73.1% from baseline at both 48 and 60 months posttreatment, respectively (both p < 0.0001). Combined hand tremor/motor scores (Parts A and B) also improved by 49.5% and 40.4% (p < 0.0001) at each respective time point. Functional disability scores (Part C) increased slightly over time but remained significantly improved through the 5 years (p < 0.0001). Similarly, QUEST scores remained significantly improved from baseline at year 4 (p < 0.0001) and year 5 (p < 0.0003). All previously reported AEs remained mild or moderate, and no new AEs were reported. CONCLUSIONS Unilateral MRgFUS thalamotomy demonstrates sustained and significant tremor improvement at 5 years with an overall improvement in quality-of-life measures and without any progressive or delayed complications. Clinical trial registration no.: NCT01827904 (ClinicalTrials.gov)

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

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