Clinical outcomes after MRI connectivity-guided radiofrequency thalamotomy for tremor.

Autor:	Wirth T; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom.; 2Neurology Department, Strasbourg University Hospital, Strasbourg, France.; 3Institute of Genetics and Molecular and Cellular Biology, University of Strasbourg, Illkirch, France., Goedemans T; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom.; 4Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Neurosurgical Center Amsterdam, The Netherlands., Rajabian A; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom., Dayal V; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom.; 5Neurology Department, Auckland City Hospital, Auckland, New Zealand., Abuhusain H; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom.; 6Neurosurgery Department, Royal Hallamshire Hospital, Sheffield, United Kingdom; and., Vijiaratnam N; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom., Athauda D; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom., Hariz M; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom.; 7Department of Clinical Science, Neuroscience, Umeå University, Umeå, Sweden., Foltynie T; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom., Limousin P; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom., Akram H; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom., Zrinzo L; 1Department of Clinical and Movement Neurosciences, Unit of Functional Neurosurgery, National Hospital for Neurology and Neurosurgery, UCLH-UCL Queen Square Institute of Neurology, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2023 Oct 13; Vol. 140 (4), pp. 1148-1154. Date of Electronic Publication: 2023 Oct 13 (Print Publication: 2024).
DOI:	10.3171/2023.7.JNS222744
Abstrakt:	Objective: Radiofrequency thalamotomy (RF-T) is an established treatment for refractory tremor. It is unclear whether connectivity-guided targeting strategies could further augment outcomes. The aim of this study was to evaluate the efficacy and safety of MRI connectivity-guided RF-T in severe tremor. Methods: Twenty-one consecutive patients with severe tremor (14 with essential tremor [ET], 7 with Parkinson's disease [PD]) underwent unilateral RF-T at a single institution between 2017 and 2020. Connectivity-derived thalamic segmentation was used to guide targeting. Changes in the Fahn-Tolosa-Marin Rating Scale (FTMRS) were recorded in treated and nontreated hands as well as procedure-related side effects. Results: Twenty-three thalamotomies were performed (with 2 patients receiving a repeated intervention). The mean postoperative assessment time point was 14.1 months. Treated-hand tremor scores improved by 63.8%, whereas nontreated-hand scores deteriorated by 10.1% (p < 0.01). Total FTMRS scores were significantly better at follow-up compared with baseline (mean 34.7 vs 51.7, p = 0.016). Baseline treated-hand tremor severity (rho = 0.786, p < 0.01) and total FTMRS score (rho = 0.64, p < 0.01) best correlated with tremor improvement. The most reported side effect was mild gait ataxia (n = 11 patients). Conclusions: RF-T guided by connectivity-derived segmentation is a safe and effective option for severe tremor in both PD and ET.
Databáze:	MEDLINE
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