![]() ![]() S1 in the Supplementary Appendix, available with the full text of this article at ). 18,19 The subsequent introduction of phased-array transducers 20 eliminated the need for a craniotomy, and high-resolution imaging 21,22 allows real-time, image-guided lesioning (see Fig. 17 Initial procedures required craniotomy to establish an acoustic window for the treatment of movement disorders and psychiatric conditions. The use of ultrasound energy for the creation of discrete intracranial lesions (hereafter referred to as lesioning) has been of interest since the middle of the 20th century. Two surgical therapies, radiofrequency thalamotomy and deep-brain stimulation, effectively suppress tremor, 2-16 but relatively few patients choose surgery because of perceived invasiveness from the burr holes and intracerebral electrodes. 7-11 If resistance to medications develops or side effects are unacceptable, neurosurgical intervention is considered, primarily targeting the nucleus ventralis intermedius of the thalamus, a component of tremor circuitry that connects the cerebellum with cortical motor pathways. 4-6Ĭlass I evidence exists for propranolol and primidone as first-line medications that reduce tremor by approximately 60% in 50% of patients. 2,3 Essential tremor does not shorten life expectancy, but it can affect quality of life, functional activities, mood, and socialization. (Funded by InSightec and others number, NCT01827904.) IntroductionĮssential tremor, the most common movement disorder, 1 is characterized by a distinctive postural and intention tremor typically affecting the hands more than the legs, trunk, head, or voice. Side effects included sensory and gait disturbances. MRI-guided focused ultrasound thalamotomy reduced hand tremor in patients with essential tremor. Adverse events in the thalamotomy group included gait disturbance in 36% of patients and paresthesias or numbness in 38% these adverse events persisted at 12 months in 9% and 14% of patients, respectively. Secondary outcome measures assessing disability and quality of life also improved with active treatment (the blinded thalamotomy cohort)as compared with the sham procedure (P<0.001 for both comparisons). The improvement in the thalamotomy group was maintained at 12 months (change from baseline, 7.2 points 95% CI, 6.1 to 8.3). Hand-tremor scores improved more after focused ultrasound thalamotomy (from 18.1 points at baseline to 9.6 at 3 months) than after the sham procedure (from 16.0 to 15.8 points) the between-group difference in the mean change was 8.3 points (95% confidence interval, 5.9 to 10.7 P<0.001). ![]() Seventy-six patients were included in the analysis. After 3 months, patients in the sham-procedure group could cross over to active treatment (the open-label extension cohort). The primary outcome was the between-group difference in the change from baseline to 3 months in hand tremor, rated on a 32-point scale (with higher scores indicating more severe tremor). Tremor assessments were videotaped and rated by an independent group of neurologists who were unaware of the treatment assignments. The Clinical Rating Scale for Tremor and the Quality of Life in Essential Tremor Questionnaire were administered at baseline and at 1, 3, 6, and 12 months. We enrolled patients with moderate-to-severe essential tremor that had not responded to at least two trials of medical therapy and randomly assigned them in a 3:1 ratio to undergo unilateral focused ultrasound thalamotomy or a sham procedure. Uncontrolled pilot studies have suggested the efficacy of focused ultrasound thalamotomy with magnetic resonance imaging (MRI) guidance for the treatment of essential tremor. The most trusted, influential source of new medical knowledge and clinical best practices in the world. 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. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making. ![]()
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