The use of ultrasound in the brain has been of interest for decades. 10,11 The creation of lesions in the ventral intermediate nucleus of the thalamus or electrical stimulation of the same region, which is part of a large tremor circuit that integrates kinesthetic and proprioceptive sensory information from the cerebellum and spinal cord with the cerebral cortex, are effective surgical interventions for tremor, 12-14 but many patients are reluctant to undergo such invasive surgeries. 6,7Ĭontemporary medical therapies are often successful, 8,9 but as many as 50% of patients with essential tremor cannot tolerate medications or have refractory, disabling tremor despite receiving the recommended doses of such medications. 7 Only a small proportion of such patients seek treatment. 2 The degree of tremor does not always correlate with the severity of disability, 3 and patients with essential tremor often have lower perceived health status 4,5 and are at increased risk for social phobias 6 and depression. Although essential tremor is not medically dangerous, it is progressive and disabling in the home and workplace. 1 The cause of this disorder remains unknown, although there is often a familial component with a link to a particular polymorphism in the gene encoding leucine-rich repeat and immunoglobulin domain–containing protein 1 ( LINGO1). (Funded by the Focused Ultrasound Surgery Foundation number, NCT01304758.) IntroductionĮssential tremor, the most common movement disorder, with a prevalence as high as 4%, is characterized by a rhythmic oscillation of agonist and antagonist muscle groups, typically between 8 and 12 Hz. Large, randomized, controlled trials will be required to assess the procedure's efficacy and safety. In this pilot study, essential tremor improved in 15 patients treated with MRI-guided focused ultrasound thalamotomy. Quality-of-life scores improved from 37% to 11% (P=0.001). Disability scores improved from 18.2 to 2.8 (P=0.001). Total tremor scores improved from 54.9 to 24.3 (P=0.001). Scores for hand tremor improved from 20.4 at baseline to 5.2 at 12 months (P=0.001). Adverse effects of the procedure included transient sensory, cerebellar, motor, and speech abnormalities, with persistent paresthesias in four patients. Thermal ablation of the thalamic target occurred in all patients. We assessed the patients' perceptions of treatment efficacy with the Quality of Life in Essential Tremor Questionnaire (ranging from 0 to 100%, with higher scores indicating greater perceived disability). We recorded all safety data and measured the effectiveness of tremor suppression using the Clinical Rating Scale for Tremor to calculate the total score (ranging from 0 to 160), hand subscore (primary outcome, ranging from 0 to 32), and disability subscore (ranging from 0 to 32), with higher scores indicating worse tremor. Methodsįrom February 2011 through December 2011, in an open-label, uncontrolled study, we used transcranial MRI-guided focused ultrasound to target the unilateral ventral intermediate nucleus of the thalamus in 15 patients with severe, medication-refractory essential tremor. This preliminary study investigates the use of transcranial MRI-guided focused ultrasound thalamotomy for the treatment of essential tremor. Recent advances have enabled delivery of high-intensity focused ultrasound through the intact human cranium with magnetic resonance imaging (MRI) guidance. The most trusted, influential source of new medical knowledge and clinical best practices in the world. #Focused ultrasound for essential tremor license#Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. #Focused ultrasound for essential tremor trial#NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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