Objective: To report the efficacy and safety of unilateral thalamotomy at Ventralis intermediate nucleus (VIM) by MR guided High-Intensity Focused Ultrasound (MRgHIFU) in treatment of essential (ET) and Parkinson’s disease (PD). To ascertain whether patients’ demographic and clinical characteristics influence the clinical outcome and side effects

Background: Several studies reported the benefit/risk ratio of unilateral thalamotomy by MRgHIFU in tremor benefit and adverse events. However,no regression studies were done so far in large series of patients to study patient variables that might influence MRgHIFU clinical outcome

Method: In this open-label, single center study 154 patients (103 ET, 51 PD) were treated. Patients were assessed prior and 1, 3 and 6 months after the procedure, using the CRST total and subscales A, B and C and UPDRS III subscale for tremor, for treated hemibody respectively in ET and PD patients. Treatment-related adverse events classified accordingly to type and severity were registered. Results were presented as percentage of improvement and analysed with mixed model for repeated measures. Logistic regression was applied for the presence of adverse events and percentage of improvement. Age, gender, disease duration, Fazekas score, clotting,cardiovascular risk and concomitant neurological history was introduced in the logistic regression

Results: ET patients showed improvement of CRST of 84,01% and 82,16% (p<0.001) at 1 and 6 months after treatment (table 1). Improvement of UPDRS III of 82,36% and 69,44% (p<0.001) in PD patients were found at 1 and 6 months after treatment. At month 1 post-treatment AE were present in 74.5% of the patients (83% mild,15% moderate,4% severe); however proportion of AE at month 6 diminished to 28,9%(95% mild,5% moderate) (fig 1) including mild transient ataxia, dysmetria and paraesthesia of contralateral hand in order of frequency. In the logistic regression,the only variable that showed statistically significant differences was concomitant neurological history,specifically instability (OR 4.53 at 6-month, p=0.025) for the presence of side effects as ataxia

Conclusion: This is the largest reported study confirming that MRgHIFU is a safe and effective treatment for ET and PD tremor.These results are independent from demographic and clinical features of patients except from the effect of instability in the appearance of ataxia as side effect

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mr-guided-high-intensity-ultrasound-thalamotomy-in-essential-tremor-and-parkinsons-disease-is-there-an-ideal-candidate/