Artikel
Comparative evaluation of magnetic resonance-guided focused ultrasound surgery for essential tremor
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Autoren
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Minsoo Kim
- Yonsei University Severance Hospital, Seoul, Korea
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Na Young Jung
- Yonsei University Severance Hospital, Seoul, Korea
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Young Goo Kim
- Yonsei University Severance Hospital, Seoul, Korea
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Won Seok Chang
- Yonsei University Severance Hospital, Seoul, Korea
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Hyun Ho Jung
- Yonsei University Severance Hospital, Seoul, Korea
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Yong Gou Park
- Yonsei University Severance Hospital, Seoul, Korea
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Jin Woo Chang
- Yonsei University Severance Hospital, Seoul, Korea
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Treatment options for essential tremor (ET), one of the most common types of tremor, are still limited and sometimes not satisfactory. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is an emerging technique for treatment of refractory essential tremor. This study aimed to evaluate the potential of MRgFUS treatment as an alternative to radiofrequency (RF) thalamotomy and deep brain stimulation (DBS) in patients with refractory ET in regards of the 1-year efficacy and treatment-related morbidities.
Method: A retrospective review was conducted on patients who underwent MRgFUS, and DBS from 2012 and 2014, and RF thalamotomy from 1999 to 2005. Twenty-three subjects who had taken MRgFUS, 19 DBS, and 17 RF thalamotomy were enrolled in the analysis. Tremor severity and treatment-related complications were used to document surgical outcome.
Results: Tremor severity was improved in all patients immediately after surgery. Twenty-one patients (91.3%) had taken MRgFUS, 89.5% DBS, 76.5% RF thalamotomy showed absence or mild tremor immediately after surgery. After 12 month follow-up, 78.3% of MRgFUS, 84.2% DBS, 70.6% RF thalamotomy maintained symptoms free or mild tremor. Percentage of the patients with absence of tremor at the time of 12 month after surgery was 34.8%, 47.4%, and 29.4%, respectively. Treatment-related complication was occurred after surgery in 3 (13.0%) of MRgFUS, 4 (21.1%) DBS, and 6 (35.3%) RF thalamotomy group, which remained in one (4.3%), none (0%), and two (11.8%) patients after 12 months. However, 3 patients in DBS group developed balance problem with the stimulation which did not occurred just after the procedure. Efficacy after surgery for each treatment modality showed no statistical difference, and the MRgFUS and DBS had less treatment-related side effects compared to that of RF thalamotomy.
Conclusions: MRgFUS has efficacy at least as good as RF thalamotomy and DBS, and significantly low complications than RF thalamotomy. Patients with essential tremor who are not good candidate for DBS may consider MRgFUS as second choice.
