AUTHOR=Cesarano Simone , Saporito Gennaro , Sucapane Patrizia , Bruno Federico , Catalucci Alessia , Pistoia Maria Letizia , Splendiani Alessandra , Ricci Alessandro , Di Cesare Ernesto , Totaro Rocco , Pistoia Francesca 

TITLE=Staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of bilateral essential tremor and Parkinson’s disease related tremor: a systematic review and critical appraisal of current knowledge

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1409727

DOI=10.3389/fneur.2024.1409727

ISSN=1664-2295

ABSTRACT=Introduc.on: Essen'al Tremor (ET) and Parkinson's Disease (PD) are debilita'ng neurodegenera've disorders characterized by tremor as a predominant symptom, significantly impac'ng pa'ents' quality of life. Magne'c Resonance-guided Focused Ultrasound (MRgFUS) Thalamotomy is an innova've therapeu'c op'on for the treatment of unilateral medically refractory tremor with fewer adverse effects compared to tradi'onal surgical interven'ons. A recent CE approval allows appropriate pa'ents to have their second side treated.The objec've of this systema'c review was to analyze available current knowledge about the use of MRgFUS for the treatment of bilateral ET and PD related tremor, to iden'fy the effec'veness and the risks associated with bilateral treatment.Methods: Eligible studies were iden'fied by searching published studies in PubMed and Scopus databases from May 2014 to January 2024 and by iden'fying ongoing studies registered on the clinicaltrials.gov website. Data were summarized by considering the following informa'on topics: the number of pa'ents involved, the selected lesion target, the assessment tool used to evaluate clinical changes, the observed improvement, the reported side effects, and the 'me interval between the two treatments. The study was registered in PROSPERO (ID: CRD42024513178) Results: Nine studies were eligible for this review, 7 for ET and 2 for PD. The involved popula'on included a variable number of pa'ents, ranging from 1 to 11 subjects for ET and from 10 to 15 subjects for PD. The main lesional targets were the ventral intermediate nucleus of the thalamus, the pallido-thalamic tract and the cerebello-thalamic tract bilaterally. All studies inves'gated the tremor relief through the Clinical Ra'ng Scale for Tremor (CRST) in pa'ents with ET, and through the Unified Parkinson's Disease Ra'ng Scale (UPDRS) in pa'ents with PD. A variable degree of improvement was observed, with all pa'ents expressing overall sa'sfac'on with the bilateral treatment. Adverse events were mild and transient, primarily involving gait disturbances, dysarthria, and ataxia. A standardized protocol for administering the two consecu've treatments was not iden'fiable; typically, the 'ming of the second treatment was delayed by at least six months.Available evidence supports the effec'veness and safety of staged bilateral MRgFUS treatments for ET and PD-related tremor.