Efficacy and Safety of Magnetic Resonance-Guided Focused Ultrasound Thalamotomy in Essential Tremor: A Systematic Review and Metanalysis

IF 7.6 1区医学 Q1 CLINICAL NEUROLOGY Movement Disorders Pub Date : 2025-04-17 DOI:10.1002/mds.30188

Alyssa Shiramba MRes, Steven Lane PhD, Nicola Ray PhD, Tom Gilbertson MD, MRCP, PhD, Rajesha Srinivasaiah MD, MRCP, Jay Panicker MD, MRCP, Mark Radon MD, MRCP, Jibril Osman-Farah MD, FRCS, Antonella Macerollo MD, FRCP, PhD

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Abstract

Background

Magnetic resonance-guided focused ultrasound (MRgFUS) is an established surgical treatment for essential tremor, providing tremor relief without the need for an incision or general anesthesia. Meta-analyses have been limited in their exploration of the durability of the treatment effect.

Objectives

The study aimed to assess the treatment effect and safety of this procedure over time. Different to other meta-analyses, this study assessed the durability of efficacy over time from 1 month to 5 years follow-up. Investigating the recurrence of tremor was an important target of this work.

Methods

A systematic search of the literature utilizing set search criteria was conducted with the PubMed, Scopus, Web of Science, and Cochrane library databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data analysis was conducted in R, utilizing a random-effects model for meta-analysis and a mixed-effects model for meta-regression.

Results

Forty-five studies met the inclusion criteria, of which 42 were included in the analyses. Significant changes in hand tremor, total tremor, disability scores, and quality of life scores were demonstrated across the time points investigated, the pooled standardized mean differences being −2.36 (P < 0.0001), −2.08 (P < 0.0001), −2.85 (P < 0.0001), and −1.41 (P < 0.0001) 1 year post-operation. Sensory symptoms and unsteadiness adverse events were frequently observed, with pooled proportions of 22% (95% CI 15%; 31%) and 23% (95% CI 16%; 31%) 1 month post-MRgFUS.

Conclusion

Although the procedure demonstrated efficacy and safety across the studies evaluated, meta-regression analysis suggests a decrease in treatment effect over time that requires further investigation. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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磁共振引导聚焦超声丘脑切开术治疗特发性震颤的疗效和安全性：系统综述和荟萃分析。

磁共振引导聚焦超声（MRgFUS）是一种成熟的特发性震颤手术治疗方法，无需切开或全身麻醉即可缓解震颤。荟萃分析在探索治疗效果的持久性方面受到限制。目的：本研究旨在评估该手术的治疗效果和安全性。与其他荟萃分析不同，本研究评估了1个月至5年随访期间疗效的持久性。研究震颤的复发是这项工作的一个重要目标。方法按照系统评价和荟萃分析首选报告项目（PRISMA）指南，利用设定的检索标准，在PubMed、Scopus、Web of Science和Cochrane图书馆数据库中对文献进行系统检索。数据分析采用R语言进行，meta分析采用随机效应模型，meta回归采用混合效应模型。结果45项研究符合纳入标准，其中42项纳入分析。在调查的各个时间点上，手部震颤、总震颤、残疾评分和生活质量评分发生了显著变化，术后1年的标准化平均差异分别为-2.36 （P < 0.0001）、-2.08 （P < 0.0001）、-2.85 （P < 0.0001）和-1.41 （P < 0.0001）。经常观察到感觉症状和不稳定不良事件，合并比例为22% (95% CI 15%；31%)和23% (95% CI 16%；31%) mrgfus后1个月。结论：尽管在评估的研究中，该方法证明了有效性和安全性，但meta回归分析表明，随着时间的推移，治疗效果会下降，这需要进一步的研究。©2025作者。Wiley期刊有限责任公司代表国际帕金森和运动障碍学会出版的《运动障碍》。

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来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.

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