Improving tremor response to focused ultrasound thalamotomy.

Autor:	Holcomb JM; Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA., Chopra R; Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA., Feltrin FS; Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA., Elkurd M; Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA., El-Nazer R; Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA., McKenzie L; Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA., O'Suilleabhain P; Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA., Maldjian JA; Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA., Dauer W; Department of Neurology, UTSW Medical Center, Dallas, TX 75235, USA.; O'Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA., Shah BR; Focused Ultrasound Lab and Program, Department of Radiology, UTSW Medical Center, Dallas, TX 75235, USA.; O'Donnell Brain Institute, UTSW Medical Center, Dallas, TX 75235, USA.; Department of Neurological Surgery, UTSW Medical Center, Dallas, TX 75235, USA.; Advanced Imaging Research Center, UTSW Medical Center, Dallas, TX 75235, USA.; Center for Alzheimer's and Neurodegenerative Diseases, UTSW Medical Center, Dallas, TX 75235, USA.
Jazyk:	angličtina
Zdroj:	Brain communications [Brain Commun] 2023 May 22; Vol. 5 (4), pp. fcad165. Date of Electronic Publication: 2023 May 22 (Print Publication: 2023).
DOI:	10.1093/braincomms/fcad165
Abstrakt:	MRI-guided high-intensity focused ultrasound thalamotomy is an incisionless therapy for essential tremor. To reduce adverse effects, the field has migrated to treating at 2 mm above the anterior commissure-posterior commissure plane. We perform MRI-guided high-intensity focused ultrasound with an advanced imaging targeting technique, four-tract tractography. Four-tract tractography uses diffusion tensor imaging to identify the critical white matter targets for tremor control, the decussating and non-decussating dentatorubrothalamic tracts, while the corticospinal tract and medial lemniscus are identified to be avoided. In some patients, four-tract tractography identified a risk of damaging the medial lemniscus or corticospinal tract if treated at 2 mm superior to the anterior commissure-posterior commissure plane. In these patients, we chose to target 1.2-1.5 mm superior to the anterior commissure-posterior commissure plane. In these patients, post-operative imaging revealed that the focused ultrasound lesion extended into the posterior subthalamic area. This study sought to determine if patients with focused ultrasound lesions that extend into the posterior subthalamic area have a differnce in tremor improvement than those without. Twenty essential tremor patients underwent MRI-guided high-intensity focused ultrasound and were retrospectively classified into two groups. Group 1 included patients with an extension of the thalamic-focused ultrasound lesion into the posterior subthalamic area. Group 2 included patients without extension of the thalamic-focused ultrasound lesion into the posterior subthalamic area. For each patient, the percent change in postural tremor, kinetic tremor and Archimedes spiral scores were calculated between baseline and a 3-month follow-up. Two-tailed Wilcoxon rank-sum tests were used to compare the improvement in tremor scores, the total number of sonications, thermal dose to achieve initial tremor response, and skull density ratio between groups. Group 1 had significantly greater postural, kinetic, and Archimedes spiral score percent improvement than Group 2 ( P values: 5.41 × 10 -5 , 4.87 × 10 -4 , and 5.41 × 10 -5 , respectively). Group 1 also required significantly fewer total sonications to control the tremor and a significantly lower thermal dose to achieve tremor response ( P values: 6.60 × 10 -4 and 1.08 × 10 -5 , respectively). No significant group differences in skull density ratio were observed ( P = 1.0). We do not advocate directly targeting the posterior subthalamic area with MRI-guided high-intensity focused ultrasound because the shape of the focused ultrasound lesion can result in a high risk of adverse effects. However, when focused ultrasound lesions naturally extend from the thalamus into the posterior subthalamic area, they provide greater tremor control than those that only involve the thalamus. Competing Interests: Dr Shah receives payment from Insightec for presentations using their device. The other authors have no competing interests to report. (© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.)
Databáze:	MEDLINE
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