Efficacy and Safety of Unilateral MRgFUS Thalamotomy for Essential Tremor (P7-11.006)

Le résumé fourni par la source

Objective: To report outcomes of MRI guided focused ultrasound (MRgFUS) unilateral ventral intermediate nucleus (VIM) thalamotomy in essential tremor (ET) patients at a single institution. Background: MRgFUS VIM thalamotomy is an approved non-invasive treatment for ET. In select ET patients unilateral MRgFUS VIM thalamotomy is an increasingly utilized surgical option for treatment of medication refractory tremor. Design/Methods: Patients with medication refractory ET underwent unilateral MRgFUS VIM thalamotomy at a single institution. The Essential Tremor Rating Assessment Scale (TETRAS) activities of daily living (ADL) and performance subscales, global improvement scales and adverse effects were obtained at baseline and subsequent follow-up visits ranging from 1.5–16.5 months. Results: 46 patients (24 female) underwent MRgFUS VIM thalamotomy (40 left VIM). Mean age at time of surgery was 75.0 ± 10.2 years (41.0–95.3) and disease duration was 25.9 ± 17.9 years (3.5–72.3). Mean follow-up was 7.3 ± 4.6 months. TETRAS ADL subscale improved from 26.2 at baseline to 10.8 at last follow-up (59%, p<0.001) and TETRAS performance subscale improved from 26.0 at baseline to 15.5 at last follow-up (40.4%, p<0.001). At last follow-up, 34/46 (74%) patients reported marked global improvement, 6/46 (13%) had moderate improvement and 3/46 (6.5%) had mild improvement. No change was reported by 3/46 (6.5%). Common adverse effects included gait imbalance and speech/swallowing difficulties immediately after surgery which in the majority of patients improved and resolved back to baseline at subsequent follow-up visits. One patient had poor outcome and had subsequent deep brain stimulation. Two patients had repeated MRgFUS to improve outcome and 2 had unrelated deaths greater than 4 months after surgery. Conclusions: Unilateral MRgFUS thalamotomy is a safe and effective treatment for patients with medication refractory ET. Adverse effects of speech, swallowing and gait difficulties occur related to the surgery, but in the majority of patients these adverse effects resolve over time. Disclosure: Dr. Au has nothing to disclose. Dr. Lyons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott. Dr. Lyons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sage. Dr. Lyons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Acorda. Dr. Lyons has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Supernus. Dr. Lyons has a non-compensated relationship as a President with International Essential Tremor Foundation that is relevant to AAN interests or activities. Miss O’Brien has nothing to disclose. Dr. Sharma has nothing to disclose. Jennifer Cheng, MD has nothing to disclose. Dr. Kinsman has nothing to disclose. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbott. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for AbbVie. Dr. Pahwa has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for ACADIA. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Acorda. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amneal. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cala Health. Dr. Pahwa has received personal compensation in the range of $0-$499 for serving as a Consultant for Global Kinetics. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Kyowa. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurocrine. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sunovion. Dr. Pahwa has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Supernus. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Allevion. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avion. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Insightec. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Jaaz. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neuroderm. Dr. Pahwa has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Photopharmics. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sage. Dr. Pahwa has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Wren. The institution of Dr. Pahwa has received research support from Abbott. The institution of Dr. Pahwa has received research support from Abbvie. The institution of Dr. Pahwa has received research support from Biogen. The institution of Dr. Pahwa has received research support from Biohaven. The institution of Dr. Pahwa has received research support from Boston Scientific. The institution of Dr. Pahwa has received research support from EIP. The institution of Dr. Pahwa has received research support from Global Kinetics. The institution of Dr. Pahwa has received research support from Amneal. The institution of Dr. Pahwa has received research support from Neuraly. The institution of Dr. Pahwa has received research support from Parkinson Foundation. The institution of Dr. Pahwa has received research support from Pharma 2B. The institution of Dr. Pahwa has received research support from Roche. The institution of Dr. Pahwa has received research support from Sage. The institution of Dr. Pahwa has received research support from Sun Pharma. The institution of Dr. Pahwa has received research support from Theranexus. The institution of Dr. Pahwa has received research support from Theravance. The institution of Dr. Pahwa has received research support from Voyager. The institution of Dr. Pahwa has received research support from Neuroderm.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.