Radiosurgical thalamotomy for essential tremor: state of the art, current challenges and future directions.

IF 3.4 2区 医学 Q2 CLINICAL NEUROLOGY Expert Review of Neurotherapeutics Pub Date : 2024-06-01 Epub Date: 2024-05-07 DOI:10.1080/14737175.2024.2351512
Christian Iorio-Morin, David Mathieu, Andrea Franzini, Mojgan Hodaie, Samuelle-Arianne Villeneuve, Andréanne Hamel, Andres M Lozano
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Abstract

Introduction: Essential tremor (ET) is the most frequent movement disorder, affecting up to 5% of adults > 65 years old. In 30-50% of cases, optimal medical management provides insufficient tremor relief and surgical options are considered. Thalamotomy is a time-honored intervention, which can be performed using radiofrequency (RF), stereotactic radiosurgery (SRS), or magnetic resonance-guided focused ultrasounds (MRgFUS). While the latter has received considerable attention in the last decade, SRS has consistently been demonstrated as an effective and well-tolerated option.

Areas covered: This review discusses the evidence on SRS thalamotomy for ET. Modern workflows and emerging techniques are detailed. Current outcomes are analyzed, with a specific focus on tremor reduction, complications and radiological evolution of the lesions. Challenges for the field are highlighted.

Expert opinion: SRS thalamotomy improves tremor in > 80% patients. The efficacy appears comparable to other modalities, including DBS, RF and MRgFUS. Side effects result mostly from idiosyncratic hyper-responses to radiation, which occur in up to 10% of treatments, are usually self-resolving, and are symptomatic in < 4% of patients. Future research should focus on accumulating more data on bilateral treatments, collecting long-term outcomes, refining targeting, and improving lesion consistency.

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放射外科丘脑切开术治疗本质性震颤:技术现状、当前挑战和未来方向。
简介本质性震颤(ET)是最常见的运动障碍,在 65 岁以上的成年人中发病率高达 5%。在 30-50% 的病例中,最佳的药物治疗无法充分缓解震颤,因此需要考虑手术治疗。丘脑切开术是一种历史悠久的干预方法,可通过射频(RF)、立体定向放射外科(SRS)或磁共振引导聚焦超声(MRgFUS)进行。虽然后者在过去十年中受到了广泛关注,但 SRS 一直被证明是一种有效且耐受性良好的选择:本综述讨论了 SRS 丘脑切开术治疗 ET 的证据。详细介绍了现代工作流程和新兴技术。分析了当前的疗效,重点关注震颤减轻、并发症和病变的放射学演变。专家意见:专家观点:SRS 丘脑切开术可改善超过 80% 患者的震颤。SRS丘脑切开术可改善80%以上患者的震颤,其疗效与其他方式(包括DBS、射频和磁共振超声)不相上下。副作用主要来自于对辐射的特异性高反应,最多有 10% 的治疗会出现这种副作用,通常可自行缓解,但在某些情况下会出现症状。
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来源期刊
Expert Review of Neurotherapeutics
Expert Review of Neurotherapeutics Medicine-Neurology (clinical)
CiteScore
7.00
自引率
2.30%
发文量
61
审稿时长
4-8 weeks
期刊介绍: Expert Review of Neurotherapeutics (ISSN 1473-7175) provides expert reviews on the use of drugs and medicines in clinical neurology and neuropsychiatry. Coverage includes disease management, new medicines and drugs in neurology, therapeutic indications, diagnostics, medical treatment guidelines and neurological diseases such as stroke, epilepsy, Alzheimer''s and Parkinson''s. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points
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