Abstract: Background: MR-guided focused ultrasound (MRgFUS) is an effective treatment for essential tremor (ET). However, the optimal intracranial target sites remain to be determined. Objective: To assess MRgFUS induced sequential lesions in (anterior-VIM/VOP nuclei) the thalamus and then posterior subthalamic area (PSA) performed during the same procedure for alleviating ET. Methods: 14 patients had unilateral MRgFUS lesions placed in anterior-VIM/VOP then PSA. Bain-Findley Spirals were collected during MRgFUS from the treated arm (BFS-TA) and throughout the study from the treated (BFS-TA) and non-treated (BFS-NTA) arms and scored by blinded assessors. Although, the primary outcome was change in the BFS-TA from baseline to 12 months we have highlighted the 24 month data. Secondary outcomes included the Clinical Rating Scale for Tremor (CRST), Quality of Life for ET (QUEST) and PHQ-9 depression scores. Results: The mean improvement in the BFS-TA from baseline to 24 months was 41.1% (p less than 0.001) whilst BFS-NTA worsened by 8.8% (p less than 0.001). Intra-operative BFS scores from the targeted arm showed a mean 27.9% (p less than 0.001) decrease after anterior-VIM/VOP ablation and an additional 30.1% (p less than 0.001) reduction from post anterior-VIM/VOP to post-PSA ablation. Mean improvements at 24 month follow-up in the CRST-parts A, B and C were 60.7%, 30.4% and 65.6% respectively and 37.8% in QUEST-tremor score (all p less than 0.05). Unilateral tremor severity scores decreased in the treated arm (UETTS-TA) 72.9% (p equals 0.001) and non-treated arm (UETTS-NTA) 30.5% (p less than 0.01). At 24 months residual adverse effects were slight unsteadiness in one case and mild hemi-chorea in another. Conclusion: Unilateral anterior-VIM/VOP and PSA MRgFUS significantly diminished contralateral arm tremor with improvements in arm function, tremor related disability and quality of life, with an acceptable adverse event profile.

中文翻译：

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来自针对双侧病变部位MRgFUS治疗以丘脑和丘脑后区域为目标的原发性震颤的初步研究的两年数据。

摘要：背景：MR引导聚焦超声（MRgFUS）是一种有效的治疗原发性震颤（ET）的方法。但是，最佳颅内靶位点尚待确定。目的：评估MRgFUS诱导丘脑（前VIM / VOP核）的继发性病变，然后在同一步骤中减轻丘脑后丘脑后区域（PSA）。方法：14例单侧MRgFUS病变先行VIM / VOP，然后行PSA。在MRgFUS期间，从治疗组（BFS-TA）以及整个研究期间从治疗组（BFS-TA）和未治疗组（BFS-NTA）收集贝恩-芬德利螺旋，并由盲法评估者评分。尽管主要结果是BFS-TA从基线到12个月的变化，但我们强调了24个月的数据。次要结果包括震颤临床评估量表（CRST），ET（QUEST）和PHQ-9抑郁评分的生活质量。结果：从基线到24个月，BFS-TA的平均改善为41.1％（P小于0.001），而BFS-NTA恶化了8.8％（P小于0.001）。术中BFS评分显示，前VIM / VOP消融后平均降低27.9％（P小于0.001），从前VIM / VOP到术后VSM / VOP降低30.1％（P小于0.001）。 PSA消融。CRST部分A，B和C在24个月随访中的平均改善分别为QUEST-震颤评分的60.7％，30.4％和65.6％和37.8％（所有p均小于0.05）。治疗组（UETTS-TA）的单侧震颤严重程度评分降低了72.9％（p等于0.001），未治疗组（UETTS-NTA）的单侧震颤严重度得分降低了30.5％（p小于0.01）。在24个月时，残留不良反应为一例轻微不稳定，另一例为轻度半舞蹈症。结论：单侧前VIM / VOP和PSA MRgFUS可以显着减少对侧手臂震颤，改善手臂功能，与震颤相关的残疾和生活质量，并具有可接受的不良事件特征。