Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience.

Autor:	Pérez-Sánchez JR; Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España., Martínez-Álvarez R; Servicio de Radiocirugía y Neurocirugía funcional, Hospital Ruber Internacional, Madrid, España., Martínez Moreno NE; Servicio de Radiocirugía y Neurocirugía funcional, Hospital Ruber Internacional, Madrid, España., Torres Diaz C; Servicio de Radiocirugía y Neurocirugía funcional, Hospital Ruber Internacional, Madrid, España; Servicio de Neurocirugía, Hospital Universitario de la Princesa, Madrid, España., Rey G; Servicio de Radiocirugía y Neurocirugía funcional, Hospital Ruber Internacional, Madrid, España., Pareés I; Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España., Del Barrio A A; Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España., Álvarez-Linera J; Servicio de Radiología, Hospital Ruber Internacional, Madrid, España., Kurtis MM; Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ruber Internacional, Madrid, España. Electronic address: mkurtis@ruberinternacional.es.
Jazyk:	English; Spanish; Castilian
Zdroj:	Neurologia [Neurologia (Engl Ed)] 2020 Sep 08. Date of Electronic Publication: 2020 Sep 08.
DOI:	10.1016/j.nrl.2020.05.014
Abstrakt:	Introduction: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. Methods: We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months' follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. Results: Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. Conclusions: This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants. (Copyright © 2020 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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