Fibrinogen and hypertension are key factors associated with tremor relieve and recurrence in the ET patients subjected with MRgFUS thalamotomy

Abstract

AbstractBackgroundThere were variable differences and declines in efficacy of magnetic resonance guided focused ultrasound (MRgFUS) thalamotomy, but whether the clinical status of these patients was involved was still unknown.MethodsWe retrospectively reviewed the tremor symptoms and clinical variables (at hospitalization) of 59 essential tremor (ET) patients subjected with MRgFUS thalamotomy. Patients were categorized by the short-term tremor relieve, tremor recurrence within 12 months and long-term maintenance outcome. Multivariate logistic regression was used to screen independent factors and construct the nomogram. Additional harmaline-induced ET model in male ICR mice were employed, we evaluated the possible anti-tremor effects of fibrinogen knock-out.ResultsMRgFUS thalamotomy resulted in significant tremor relieve, multivariate analysis suggested fibrinogen (OR = 0.182, 95% CI = 0.042-0.796,) and monocyte count (OR = 0, 95% CI = 0-0.001) were independently associated with better short-term tremor relieve (>75%) at 1-month postoperatively. A total of nine ET patients (15.254%) experienced significant tremor recurrence. Admission systolic blood pressure (OR = 1.013, 95% CI = 1.010-1.062), hypertension comorbidity (OR = 2.163, 95% CI = 1.412-53.565) and fibrinogen (OR = 1.620, 95% CI = 1.047-24.376) independently contributed to tremor recurrence. There were 15 ET patients (25.424%) sustained long-term and effective tremor control. Only admission systolic blood pressure was the independent prognostic factor (OR = 0.880, 95% CI = 0.785-0.987) for this favorable outcome. The nomograms were established for better tremor relieve and tremor recurrence and have excellent performance as the AUCs were 0.829 and 0.853 (bootstrap repetition = 1000). Finally, FGB knock-out significantly suppressed harmaline-induced tremorin vivo(P< 0.001).ConclusionFibrinogen and hypertension are key factors associated with tremor relieve and recurrence in the ET patients subjected with MRgFUS thalamotomy.