Unilateral cerebellothalamic tract ablation in essential tremor by MRI-guided focused ultrasound.

Schreglmann, Sebastian R; Bauer, Ronald; Hägele-Link, Stefan; Bhatia, Kailash P; Natchev, Parashkev; Wegener, Nikolas; Lebeda, Anita; Werner, Beat; Martin, Ernst; Kägi, Georg (2017). Unilateral cerebellothalamic tract ablation in essential tremor by MRI-guided focused ultrasound. Neurology, 88(14), pp. 1329-1333. Lippincott Williams & Wilkins 10.1212/WNL.0000000000003795

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OBJECTIVE To report results of a prospective trial of unilateral transcranial MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract in essential tremor (ET). METHODS This was a prospective, uncontrolled, single-center interventional study. Patients with ET fulfilling criteria for interventional therapy received unilateral ablation of the cerebellothalamic tract (CTT) by MRIgFUS. Motor symptoms, manual dexterity, cognition, and quality of life were assessed before intervention and at 48 hours and 1, 3, and 6 months after intervention. Rating of standardized video recordings was blinded for evaluation time points. Primary outcome was the change in unilateral hand tremor score of the treated hand. RESULTS Six patients received MRIgFUS ablation of the CTT contralateral to the treated hand. Repeated-measures comparison determined a statistically significant 83% reduction (before vs 6 months after intervention mean ± SD; absolute reduction; 95% confidence interval) in the unilateral treated hand subscore (14.3 ± 4.9 vs 2.5 ± 2.6; 11.8; 8.4-15.2; p < 0.001), while quality of life improved by 52% (50.5 ± 19.4 vs 24.8 ± 11.4; 25.7; 3.5-47.28; p = 0.046). Measures for manual dexterity, attention and coordination, and overall cognition were unchanged. Transient side effects (n = 3) were ipsilateral hand clumsiness and mild gait instability for up to 3 months. CONCLUSIONS Unilateral MRIgFUS lesioning of the CTT was highly efficacious in reducing contralateral hand tremor in ET without affecting fine motor function and dexterity over 6 months of follow-up. Adverse effects were mild and transient. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with ET, transcranial MRIgFUS ablation of the cerebellothalamic tract improves tremor.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Kägi, Georg

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0028-3878

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

23 Oct 2017 10:28

Last Modified:

23 Oct 2017 10:28

Publisher DOI:

10.1212/WNL.0000000000003795

PubMed ID:

28275083

URI:

https://boris.unibe.ch/id/eprint/102133

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