Tremor suppression following treatment with MRgFUS: skull density ratio consistency and degree of posterior dentatorubrothalamic tract lesioning predicts long-term clinical outcomes in essential tremor

Frontiers in Neurology

Neurology

Arkiev D’Souza¹  Fernando Calamante²  Kain Kyle³  Chenyu Wang³  Michael Barnett⁴  Yael Barnett⁵  James Peters⁶  Joel Maamary⁷  Stephen Tisch⁷  Benjamin Jonker⁸  Jerome Maller⁹ 

[1] Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia;Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia;School of Biomedical Engineering, The University of Sydney, Sydney, NSW, Australia;Sydney Imaging, The University of Sydney, Sydney, NSW, Australia;Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia;Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia;Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia;Sydney Neuroimaging Analysis Centre, Camperdown, NSW, Australia;Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia;Department of Medical Imaging, and Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia;Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia;Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia;Department of Neurology, St Vincent’s Hospital, Darlinghurst, NSW, Australia;School of Medicine, University of New South Wales, Sydney, NSW, Australia;Department of Neurosurgery, St Vincent’s Hospital, Darlinghurst, NSW, Australia;Royal Prince Alfred Institute of Academic Surgery, University of Sydney, Camperdown, NSW, Australia;GE Healthcare, Melbourne, VIC, Australia;

关键词: vim;    dentatorubrothalamic tract;    essential tremor;    MRgFUS;    tremor;   

DOI  :  10.3389/fneur.2023.1129430

 received in 2022-12-22, accepted in 2023-03-27,  发布年份 2023

来源: Frontiers

【 摘 要 】

ObjectivesMagnetic resonance-guided focussed ultrasound (MRgFUS) is an incisionless ablative procedure, widely used for treatment of Parkinsonian and Essential Tremor (ET). Enhanced understanding of the patient- and treatment-specific factors that influence sustained long-term tremor suppression could help clinicians achieve superior outcomes via improved patient screening and treatment strategy.MethodsWe retrospectively analysed data from 31 subjects with ET, treated with MRgFUS at a single centre. Tremor severity was assessed with parts A, B and C of the Clinical Rating Scale for Tremor (CRST) as well as the combined CRST. Tremor in the dominant and non-dominant hand was assessed with Hand Tremor Scores (HTS), derived from the CRST. Pre- and post-treatment imaging data were analysed to determine ablation volume overlap with automated thalamic segmentations, and the dentatorubrothalamic tract (DRTT) and compared with percentage change in CRST and HTS following treatment.ResultsTremor symptoms were significantly reduced following treatment. Combined pre-treatment CRST (mean: 60.7 ± 17.3) and HTS (mean: 19.2 ± 5.7) improved by an average of 45.5 and 62.6%, respectively. Percentage change in CRST was found to be significantly negatively associated with age (β = −0.375, p = 0.015), and SDR standard deviation (SDRSD; β = −0.324, p = 0.006), and positively associated with ablation overlap with the posterior DRTT (β = 0.535, p < 0.001). Percentage HTS improvement in the dominant hand decreased significantly with older age (β = −0.576, p < 0.01).ConclusionOur results suggest that increased lesioning of the posterior region of the DRTT could result in greater improvements in combined CRST and non-dominant hand HTS, and that subjects with lower SDR standard deviation tended to experience greater improvement in combined CRST.

【 授权许可】

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Copyright © 2023 Kyle, Maller, Barnett, Jonker, Barnett, D’Souza, Calamante, Maamary, Peters, Wang and Tisch.