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Published online: 2024-05-14

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Unilateral gamma knife thalamotomy for tremor safety and efficacy in multimodal assessment: a prospective case-control study with two-year follow-up

Monika Figura1, Joanna Przytycka1, Sebastian Dzierzęcki2, Mateusz Szumilas3, Stanisław Szlufik1, Łukasz Milanowski1, Maria Kłoda14, Karolina Duszyńska-Wąs1, Renata Kowalska-Taczanowska1, Agnieszka Drzewińska1, Karol Sadowski5, Aleksandra Korn5, Anna Ziobro5, Katarzyna Bochniak5, Andrzej Friedman1, Mirosław Ząbek26, Dariusz Koziorowski1

Abstract

Introduction. Unilateral gamma knife thalamotomy (GKT) is a treatment option for pharmacoresistant tremor of various aetiologies. There have been to date no randomised controlled trials performed to assess its safety and efficacy. Our aim was to summarise a two-year multimodal observation of patients with tremor caused by Parkinson’s Disease (PD) or essential tremor (ET).

Material and methods. 23 patients with PD (n = 12) or ET (n = 11) were included. They underwent assessments before, V0 (n = 23), and 12 months, V12 (n = 23), and 24 months, V24 (n = 15), after unilateral GKT. Patients were assessed with psychological tests and acoustic voice analysis. Tremor assessment was performed with a digitising table using the Fahn-Tolosa-Marin rating scale (FTMRS). The Unified Parkinson’s Disease rating scale part III (UPDRS-III) was also used in the PD group. Gait and balance was assessed using clinical tests, stabilometric platform, and treadmill.

Results. No side effects were observed in a two-year follow-up. There was no notable deterioration observed in the patients’ psychological evaluation, speech, or assessment of gait and balance. The scores were significantly lower (p = 0.01) in parts A and B of FTMRS one year after GKT. In post hoc analysis, the scores did not differ significantly between V0 and V24. In FTMRS part C (activities of daily living), no significant change was observed. There was no significant difference in total UPDRS part III score or in score of UPDRS part III domains 3 and 4 (‘tremor at rest’ and ‘action and postural tremor of hands’) between measurements.

Conclusions. UGKT may be a safe treatment modality if performed in an experienced centre. Tremor reduction may diminish over time, and UGKT did not lead to cognitive, gait or speech deterioration in a long-term observation.

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References

  1. Wenning GK, Kiechl S, Seppi K, et al. Prevalence of movement disorders in men and women aged 50-89 years (Bruneck Study cohort): a population-based study. Lancet Neurol. 2005; 4(12): 815–820.
  2. Louis ED, Ferreira JJ. How common is the most common adult movement disorder? Update on the worldwide prevalence of essential tremor. Mov Disord. 2010; 25(5): 534–541.
  3. Krüger MT, Avecillas-Chasin JM, Tamber MS, et al. Tremor and Quality of Life in Patients With Advanced Essential Tremor Before and After Replacing Their Standard Deep Brain Stimulation With a Directional System. Neuromodulation. 2021; 24(2): 353–360.
  4. Belvisi D, Conte A, Cutrona C, et al. Re-emergent tremor in Parkinson's disease: the effect of dopaminergic treatment. Eur J Neurol. 2018; 25(6): 799–804.
  5. Egberts A, Moreno-Gonzalez R, Alan H, et al. Anticholinergic Drug Burden and Delirium: A Systematic Review. J Am Med Dir Assoc. 2021; 22(1): 65–73.e4.
  6. Kwaśniak-Butowska M, Dulski J, Pierzchlińska A, et al. Cardiovascular dysautonomia and cognition in Parkinson's Disease - a possible relationship. Neurol Neurochir Pol. 2021; 55(6): 525–535.
  7. Hopfner F, Deuschl G. Managing Essential Tremor. Neurotherapeutics. 2020; 17(4): 1603–1621.
  8. Ferreira JJ, Mestre TA, Lyons KE, et al. MDS Task Force on Tremor and the MDS Evidence Based Medicine Committee. MDS evidence-based review of treatments for essential tremor. Mov Disord. 2019; 34(7): 950–958.
  9. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases. Beta Adrenergic Blocking Agents. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. 2012.
  10. Lenka A, Louis ED. Primidone Intolerance in Essential tremor: Is it More than Just Age? Tremor Other Hyperkinet Mov (N Y). 2021; 11: 57.
  11. Zheng X, Wei W, Liu P, et al. Botulinum toxin type A for hand tremor: a meta-analysis of randomised controlled trials. Neurol Neurochir Pol. 2020; 54(6): 561–567.
  12. Kondziolka D. Functional radiosurgery. Neurosurgery. 1999; 44(1): 12–20; discussion 20 -22.
  13. Niranjan A, Lunsford D, Kano H. Leksell Radiosurgery. Progress in Neurological Surgery 2019.
  14. Campbell AM, Glover J, Chiang VLS, et al. Gamma knife stereotactic radiosurgical thalamotomy for intractable tremor: a systematic review of the literature. Radiother Oncol. 2015; 114(3): 296–301.
  15. Iorio-Morin C, Hodaie M, Lozano AM. Adoption of focused ultrasound thalamotomy for essential tremor: why so much fuss about FUS? J Neurol Neurosurg Psychiatry. 2021; 92(5): 549–554.
  16. Schlesinger I, Eran A, Sinai A, et al. MRI Guided Focused Ultrasound Thalamotomy for Moderate-to-Severe Tremor in Parkinson's Disease. Parkinsons Dis. 2015; 2015: 219149.
  17. Vaillancourt DE, Sturman MM, Verhagen Metman L, et al. Deep brain stimulation of the VIM thalamic nucleus modifies several features of essential tremor. Neurology. 2003; 61(7): 919–925.
  18. Brinker D, Smilowska K, Paschen S, et al. European Academy of Neurology/Movement Disorder Society - European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies. Eur J Neurol. 2022; 29(9): 2580–2595.
  19. Ślubowska E, Pałko T. Spectral analysis of tremor for evaluation of handwriting disorders. Elektronika: konstrukcje, technologie, zastosowania. 2004; 45: 149–151.
  20. Kowalska-Taczanowska R, Friedman A, Koziorowski D. Parkinson's disease or atypical parkinsonism? The importance of acoustic voice analysis in differential diagnosis of speech disorders. Brain Behav. 2020; 10(8): e01700.
  21. Team RC. R: A language and environment for statistical computing. ; 2018: 2018. https://www.r-project.org/.
  22. Rohringer CR, Sewell IJ, Gandhi S, et al. Cognitive effects of unilateral thalamotomy for tremor: a meta-analysis. Brain Commun. 2022; 4(6): fcac287.
  23. Jahanshahi M, Pieter S, Alusi SH, et al. Effects on cognition of stereotactic lesional surgery for the treatment of tremor in multiple sclerosis. Behav Neurol. 2008; 20(1-2): 1–9.
  24. Kalinowska-Łyszczarz A, Guo Y, Lucchinetti CF. Update on pathology of central nervous system inflammatory demyelinating diseases. Neurol Neurochir Pol. 2022; 56(3): 201–209.
  25. Altmann CF, Koschel J, Jost WH. Predictors of falls in Parkinson's disease, progressive supranuclear palsy, and multiple system atrophy: a retrospective study. Neurol Neurochir Pol. 2023; 57(3): 297–304.
  26. Tipton PW. Dissecting parkinsonism: cognitive and gait disturbances. Neurol Neurochir Pol. 2021; 55(6): 513–524.
  27. Young RF, Li F, Vermeulen S, et al. Gamma knife thalamotomy for treatment of tremor: long-term results. J Neurosurg. 2000; 93 Suppl 3(6): 128–135.
  28. Duma CM, Jacques DB, Kopyov OV, et al. Gamma knife radiosurgery for thalamotomy in parkinsonian tremor: a five-year experience. J Neurosurg. 1998; 88(6): 1044–1049.
  29. Lindquist C, Steiner L, Hindmarsh T. Gamma knife thalamotomy for tremor: reort of two cases. Radiosurgery: baseline and trends: Raven Press New York; 1992. In: Steiner L. ed. Radiosurgery: baseline and trends. Raven Press , New York 1992: 237–243.
  30. Okun MS, Stover NP, Subramanian T, et al. Complications of gamma knife surgery for Parkinson disease. Arch Neurol. 2001; 58(12): 1995–2002.
  31. Dallapiazza RF, Lee DJ, De Vloo P, et al. Outcomes from stereotactic surgery for essential tremor. J Neurol Neurosurg Psychiatry. 2019; 90(4): 474–482.
  32. Gomes JG, Gorgulho AA, de Oliveira López A, et al. The role of diffusion tensor imaging tractography for Gamma Knife thalamotomy planning. J Neurosurg. 2016; 125(Suppl 1): 129–138.
  33. Niranjan A, Raju SS, Kooshkabadi A, et al. Stereotactic radiosurgery for essential tremor: Retrospective analysis of a 19-year experience. Mov Disord. 2017; 32(5): 769–777.
  34. Ravikumar VK, Parker JJ, Hornbeck TS, et al. Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor. Mov Disord. 2017; 32(8): 1165–1173.
  35. Kooshkabadi A, Lunsford LD, Tonetti D, et al. Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era. J Neurosurg. 2013; 118(4): 713–718.
  36. Witjas T, Carron R, Krack P, et al. A prospective single-blind study of Gamma Knife thalamotomy for tremor. Neurology. 2015; 85(18): 1562–1568.
  37. Pérez-Sánchez JR, Martínez-Álvarez R, Martínez Moreno NE, et al. Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience. Neurologia (Engl Ed). 2020 [Epub ahead of print]; 38(3): 188–196.
  38. Halpern CH, Santini V, Lipsman N, et al. Three-year follow-up of prospective trial of focused ultrasound thalamotomy for essential tremor. Neurology. 2019; 93(24): e2284–e2293.



Neurologia i Neurochirurgia Polska