Comparative Study of Focused Ultrasound Unilateral Thalamotomy and Subthalamotomy for Medication‐Refractory Parkinson's Disease Tremor

Movement Disorders, Год журнала: 2025, Номер unknown

Опубликована: Март 3, 2025

Abstract Background Unilateral focused ultrasound ventral intermediate thalamotomy (Vim‐FUS) is effective in treating Parkinson's disease (PD) tremor. Ultrasound ablation of the subthalamic nucleus (STN‐FUS) has demonstrated efficacy improving all cardinal motor features PD, including Objective To compare parkinsonian tremor control between Vim‐FUS and STN‐FUS. Methods Retrospective, two‐center study consecutive PD patients with medication‐refractory who underwent unilateral or STN‐FUS June 2015 August 2022. Patients scored ≥2 for postural and/or resting on most affected body side off‐medication state. The primary outcome was between‐group difference improvement treated at 12‐month follow‐up, a responder's analysis. Data regarding safety, global status, dopaminergic requirements were also collected. Group comparisons used repeated measures ANOVA Bonferroni correction; statistical significance P < 0.05. Results Among 175 two sites, 63 included (23 Vim‐FUS, 40 STN‐FUS). At baseline, both groups equivalent duration (6.7 ± 3.8 vs. 6.1 3.4 years, = 0.48) severity (5.7 1.5 5.9 2.5, 0.7). While benefit 4 months ( 0.15), reduction greater STN‐ FUS 12 (4.4 2.0, 95% CI 3.7–5.0 compared 2.7 3.7, 1.1–4.3 0.012). In 47.5% (19/40) completely abolished versus 8.7% (2/23) 0.01). Most adverse events mild (91%) resolved by months. Conclusions significantly improved tremor; however, subthalamotomy might have more sustained effect. © 2025 Author(s). Movement Disorders published Wiley Periodicals LLC behalf International Parkinson Disorder Society.

Язык: Английский

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Magnetic Resonance–Guided Focused Ultrasound Thalamotomy in a Prospective Cohort of 52 Patients with Parkinson's Disease: A Possible Critical Role of Age and Lesion Volume for Predicting Tremor Relapse

Movement Disorders, Год журнала: 2025, Номер unknown

Опубликована: Янв. 18, 2025

Abstract Background Magnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy of ventral intermediate (Vim) nucleus is useful to treat drug‐resistant tremor‐dominant Parkinson's disease (TdPD), but tremor relapse may occur. Predictors have been poorly investigated so far. Objective The aim this study evaluate the role clinico‐demographic, procedural, and neuroradiological variables in determining clinical response, relapse, adverse events (AEs) TdPD after MRgFUS Vim‐thalamotomy. Methods Fifty‐two patients who consecutively underwent unilateral Vim‐thalamotomy were prospectively evaluated at baseline 24 hours, 1 month, 6 months, 12 months using MDS‐UPDRS‐III off on medication conditions. AEs collected each evaluation. Lesion volume was calculated 24‐hour magnetic resonance imaging (MRI). Patients with improvement <30% considered nonresponders (when detected hours) or relapsers (if from 1‐month visit onward). Results All showed >30% hours. Tremor occurred (23%), exclusively during first month thalamotomy. Relapse associated younger age ( P = 0.030) smaller lesion 0.030). At 22 (42%) had AEs; persisted 19% 6% cases. larger lesions 0.018). mild. Conclusions effective treating TdPD. volume, make more likely persist. We suggest that a between 145 220 mm 3 T1‐weighted MRI be therapeutic window ensures control without long‐lasting AEs. © 2025 Author(s). Movement Disorders published by Wiley Periodicals LLC behalf International Parkinson Disorder Society.

Язык: Английский

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The evolution of ventral intermediate nucleus targeting in MRI-guided focused ultrasound thalamotomy for essential tremor: an international multi-center evaluation

Frontiers in Neurology, Год журнала: 2024, Номер 15

Опубликована: Март 26, 2024

Background The ventral intermediate nucleus (VIM) is the premiere target in magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for tremor; however, there no consensus on optimal coordinates ablation. This study aims to ascertain various international VIM targeting approaches (VIM-TA) and any evolution practice. Methods International MRgFUS centers were invited share VIM-TAs 2019 2021. Analyses of modification practice anatomical markers and/or tractography use carried out. Each VIM-TA was mapped relation mid-commissural point onto a 3D thalamic model created from Schaltenbrand–Wahren atlas. Results Of 39 invited, 30 participated across period, providing 26 23 results are reported as percentages number participating that year. In 2021, respectively, 96.2% ( n = 25) 95.7% 22) based their landmarks rather than tractography. Increased adoption clinical research noted, changing 34.6% 78.3%. There statistically significant change superior-inferior plane period; percentage positioned 2 mm above intercommissural line (ICL) increased 16.0% 40.9% 2021 (WRST, p &lt; 0.05). position at center contrast, medial-lateral anterior-posterior positions remained stable. 2022, 63.3% provided rationale key demographics. more likely ICL if they had experience (more 100 treatments) North American. Conclusion Across FUS have evolved superiorly (2 ICL) aid localization. phenomenon observed autonomous centers, suggesting it site tremors.

Язык: Английский

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Dual-Lesion Magnetic Resonance–Guided Focused Ultrasound Thalamotomy of the Ventralis Intermedius Nucleus and Ventralis Oralis Anterior and Posterior Nuclei for the Treatment of Tremor-Dominant Parkinson's Disease: Outcomes in 6 Treated Cases

Operative Neurosurgery, Год журнала: 2025, Номер unknown

Опубликована: Март 5, 2025

The ventralis intermedius nucleus of the thalamus (Vim) is preferred target in magnetic resonance-guided focused ultrasound (MRgFUS) for tremor-dominant Parkinson's disease (TdPD), but some patients with TdPD have persistent tremor after Vim thalamotomy. Basal ganglia outflow through oralis anterior and posterior (Voa/p) may be responsible. We present 6 cases dual Voa/p MRgFUS thalamotomies resistant to treatment. Six underwent thalamotomy intraprocedural tremors (resting 5 and/or action 1 patient), who then during same procedure. Demographic treatment information was collected. Tremor evaluated using Clinical Rating Scale (CRST)-A CRST-B. were included study. mean age 71.5 years (SD = 2.7), male (83.3%), 4 had right-sided treatments (66.7%), a repeat (16.7%). follow-up 11 months (range 6-18 months). Mean lesion coordinates from commissure X 13.9 mm, Y 7.5 Z 2 mm. targeted by moving approximately 3 mm medial initial lesion. 11.7 11.3 2.3 Five resting improved postural/action (mean CRST-B 8.8 0.4) unsatisfactory control tremor. After thalamotomy, all CRST-A hand score 3.6 0.0). For patient without tremor, (CRST 1). All improvements sustained at last except patient, regressed preoperative months. At follow-up, reported speech (33.3%) balance/gait (50%) changes. Patients refractory benefit secondary although incidence adverse effects increased.

Язык: Английский

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Focused ultrasound: focused on tremor

Expert Review of Medical Devices, Год журнала: 2025, Номер unknown

Опубликована: Апрель 4, 2025

Magnetic resonance-guided focused ultrasound (MRgFUS) has emerged as a leading noninvasive therapy for tremor, offering precise, lesion-based alternative to deep brain stimulation (DBS) and traditional lesioning techniques. By using phased arrays focus energy at intracranial targets, MRgFUS allows real-time visualization monitoring, improving safety efficacy. Initially developed essential tremor (ET), MRgFUS-VIM-thalamotomy gained widespread acceptance is now first-line option tremor-dominant Parkinson's disease (TDPD) other syndromes. This review discusses the fundamental physics of ultrasound, key anatomical clinical application thalamotomy, pallidotomy, subthalamotomy. Skull density ratio (SDR) efficiency are highlighted crucial factors affecting treatment outcomes. The evolution bilateral treatment, along with exploration novel targets such pallidothalamic tract, examined. Additionally, we discuss advancements in FUS neuromodulation, which could complement by providing temporary or reversible symptom relief. poised further revolutionize frameless technology, staged procedures, integration neuromodulation. Future developments may allow adaptive therapies that enhance both efficacy patient experience.

Язык: Английский

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High Intensity Focused Ultrasound &ndash; Longitudinal Data on Efficacy and Safety

Tremor and Other Hyperkinetic Movements, Год журнала: 2025, Номер 15, С. 18 - 18

Опубликована: Май 5, 2025

Background: High intensity focused ultrasound (HiFU) is a relatively new incisionless intervention used for treatment of essential tremor and Parkinson’s disease tremor. Understanding the indications, benefits, risks limitations HiFU, as well how it compares to deep brain stimulation (DBS), important in guiding appropriate recommendations prospective patients. Methods: Current literature on efficacy safety HiFU was reviewed. We additionally reviewed data patients who presented our center consultation, including outcomes with low skull density ratios, distances traveled procedure. Results/Discussion: an effective generally well-tolerated Adverse events, especially gait instability, are typically temporary but should be discussed The risk recurrence certain also note. Identifying candidates either remains crucial involves considering each patient’s circumstances preferences, potential adverse effects, practical aspects like access follow-up expectations. Data bilateral lesioning, use emerging targets pallidothalamic tract well.

Язык: Английский

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Recurrence of Parkinson's Disease Tremor after Focused Ultrasound Thalamotomy?

Movement Disorders, Год журнала: 2024, Номер 39(4), С. 758 - 759

Опубликована: Апрель 1, 2024

Язык: Английский

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Magnetic resonance-guided focused ultrasound unilateral thalamotomy for medically refractory essential tremor: 3-year follow-up data

Frontiers in Neurology, Год журнала: 2024, Номер 15

Опубликована: Апрель 26, 2024

Introduction Magnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy of the ventralis intermediate (Vim) nucleus is an “incisionless” treatment for medically refractory essential tremor (ET). We present data on 49 consecutive cases MRgFUS Vim followed-up 3 years and review literature studies with longer follow-up data. Methods A retrospective chart patients who underwent (January 2018–December 2020) at our institution was performed. Clinical Rating Scale Tremor (CRST) Quality Life in Essential (QUEST) scores were obtained pre-operatively each assessment side effects. Patients had post-operative magnetic resonance imaging within 24 h 1 month to figure out lesion location, size, extent. The results ≥3 summarized through a review. Results CRST total (baseline: 58.6 ± 17.1, 3-year: 40.8 18.0) subscale (A + B, baseline: 23.5 6.3, 12.8 7.9; C, 12.7 4.3, 5.8 3.9) QUEST score 38.0 14.8, 18.7 13.3) showed significant improvement that stable during 3-year follow-up. Three reported recurrence two satisfactorily retreated. Side effects by 44% (severe: 4%, mild transient: 40%). quality life cohort consistent literature. Conclusion confirmed effectiveness safety ET up years.

Язык: Английский

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Quantitative Tractography‐Based Evaluations in Essential Tremor Patients after MRgFUS Thalamotomy

Movement Disorders Clinical Practice, Год журнала: 2024, Номер unknown

Опубликована: Окт. 5, 2024

Abstract Background Magnetic resonance‐guided focused ultrasound (MRgFUS) targeting the thalamic ventral intermediate nucleus (VIM) is an innovative treatment for drug‐refractory essential tremor (ET). The relationship between lesion characteristics, dentate‐rubro‐thalamic‐tract (DRTT) involvement and clinical benefit remains unclear. Objectives To investigate whether outcome related to volume and/or its overlap with DRTT. compare reliability of probabilistic versus deterministic tractography in reconstructing DRTT improving VIM targeting. Methods Forty ET patients who underwent MRgFUS thalamotomy 2019 2022 were retrospectively analyzed. Clinical outcomes adverse effects recorded at 1/6/12 months after procedure. was generated using on preoperative diffusion‐tensor 3 T‐images location calculated. Results Probabilistic identified both decussating (d‐DRTT) non‐decussating (nd‐DRTT) components DRTT, whereas approach only one component overlapping nd‐DRTT. Despite lesions predominantly intersecting medial portion d‐DRTT, a significantly greater responder patients, we observed non‐significant correlation improvement increased d‐DRTT‐lesion ( r = 0.22, P 0.20). demonstrated significant positive 1‐day MRI 0.42, < 0.01). Conclusion Variability reconstructed position relative center mass, even among good responders, suggests that this fiber bundle unlikely be considered sole target successful ET. Indirect individualized allows more precise reproducible identification actual coordinates than direct method.

Язык: Английский

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Which Focused Ultrasound Thalamotomy Lesion Is Optimal for Dystonic Tremor?

Movement Disorders, Год журнала: 2024, Номер 39(2), С. 452 - 452

Опубликована: Фев. 1, 2024

I have read with interest the article "Outcomes of Focused Ultrasound Thalamotomy in Tremor Syndromes" by Peters et al. published Movement Disorders November 2023.1 The study evaluates effects unilateral thalamotomies ventral intermedius nucleus (VIM) different types tremors. Of particular is authors' approach implementing additional lesions posterior subthalamic area (PSA) and/or ventralis oralis anterior (VOA) when VIM thalamotomy alone was insufficient for tremor control, as noted cases where "patients had persistent clinically significant despite at least three therapeutic treatments (maximal average temperature >53° 3 s) nucleus." This nuanced raises essential points discussion. In dystonic (TD) group, there a notable prevalence PSA and VOA lesions. 24 TD patients, 4 lesions, 2 both, representing approximately 37.5% receiving beyond VIM. rate starkly contrasts lower occurrences Parkinson's disease (PD) groups, suggesting distinct lesioning strategy not simply thalamotomy. literature, previous studies indicate enhanced efficacy or conditions, warranting detailed subgroup analysis to understand differential impacts these lesion types.1-3 study's methodology, involving creation response residual tremor, identified potential limitation discussion.1 However, quantitative comparing outcomes before after this modification treatment absent. Such an crucial full impact on control.2-4 Furthermore, diversity sites, especially necessitates investigation into whether patients experience higher incidence adverse effects. A lesion-type-based could offer valuable insights safety profiles surgical interventions. findings, particularly methodological variation, pose questions about outcome variability. These details are critical clinicians tailoring strategies etiologies. recommend that authors provide expanded based types, along comprehensive evaluation modified strategy's impact. analyses would significantly enhance our understanding MRgFUS treatment, promoting development more tailored safer protocols. Thank you considering points, which believe substantially scientific rigor applicability important study. (1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical analysis: Design, Execution, Review critique; (3) Manuscript preparation: Writing first draft, critique. M.A.: 1A, 1B, 1C, 3A their sharing knowledge. author confirms approval institutional review board required work. informed patient consent confirm journal's position issues involved ethical publication affirm work consistent those guidelines. declares no disclosures report. Data applicable - new data generated.

Язык: Английский

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