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Outcomes from stereotactic surgery for essential tremor
There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful pr...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581115/ https://www.ncbi.nlm.nih.gov/pubmed/30337440 http://dx.doi.org/10.1136/jnnp-2018-318240 |
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author | Dallapiazza, Robert Francis Lee, Darrin J De Vloo, Philippe Fomenko, Anton Hamani, Clement Hodaie, Mojgan Kalia, Suneil K Fasano, Alfonso Lozano, Andres M |
author_facet | Dallapiazza, Robert Francis Lee, Darrin J De Vloo, Philippe Fomenko, Anton Hamani, Clement Hodaie, Mojgan Kalia, Suneil K Fasano, Alfonso Lozano, Andres M |
author_sort | Dallapiazza, Robert Francis |
collection | PubMed |
description | There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful presentation and discussion of the benefits and drawbacks of each. We conducted a literature review to compare the attributes and make an appraisal of these various procedures. DBS was the most commonly reported treatment for ET. One-year tremor reductions ranged from 53% to 63% with unilateral Vim DBS. Similar improvements were demonstrated with RF (range, 74%–90%), RS (range, 48%–63%) and FUS thalamotomy (range, 35%–75%). Overall, bilateral Vim DBS demonstrated more improvement in tremor reduction since both upper extremities were treated (range, 66%–78%). Several studies show continued beneficial effects from DBS up to five years. Long-term follow-up data also support RF and gamma knife radiosurgical thalamotomy treatments. Quality of life measures were similarly improved among patients who received all treatments. Paraesthesias, dysarthria and ataxia were commonly reported adverse effects in all treatment modalities and were more common with bilateral DBS surgery. Many of the neurological complications were transient and resolved after surgery. DBS surgery had the added benefit of programming adjustments to minimise stimulation-related complications. Permanent neurological complications were most commonly reported for RF thalamotomy. Thalamic DBS is an effective, safe treatment with a long history. For patients who are medically unfit or reluctant to undergo DBS, several thalamic lesioning methods have parallel benefits to unilateral DBS surgery. Each of these surgical modalities has its own nuance for treatment and patient selection. These factors should be carefully considered by both neurosurgeons and patients when selecting an appropriate treatment for ET. |
format | Online Article Text |
id | pubmed-6581115 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65811152019-07-05 Outcomes from stereotactic surgery for essential tremor Dallapiazza, Robert Francis Lee, Darrin J De Vloo, Philippe Fomenko, Anton Hamani, Clement Hodaie, Mojgan Kalia, Suneil K Fasano, Alfonso Lozano, Andres M J Neurol Neurosurg Psychiatry Movement Disorders There are several different surgical procedures that are used to treat essential tremor (ET), including deep brain stimulation (DBS) and thalamotomy procedures with radiofrequency (RF), radiosurgery (RS) and most recently, focused ultrasound (FUS). Choosing a surgical treatment requires a careful presentation and discussion of the benefits and drawbacks of each. We conducted a literature review to compare the attributes and make an appraisal of these various procedures. DBS was the most commonly reported treatment for ET. One-year tremor reductions ranged from 53% to 63% with unilateral Vim DBS. Similar improvements were demonstrated with RF (range, 74%–90%), RS (range, 48%–63%) and FUS thalamotomy (range, 35%–75%). Overall, bilateral Vim DBS demonstrated more improvement in tremor reduction since both upper extremities were treated (range, 66%–78%). Several studies show continued beneficial effects from DBS up to five years. Long-term follow-up data also support RF and gamma knife radiosurgical thalamotomy treatments. Quality of life measures were similarly improved among patients who received all treatments. Paraesthesias, dysarthria and ataxia were commonly reported adverse effects in all treatment modalities and were more common with bilateral DBS surgery. Many of the neurological complications were transient and resolved after surgery. DBS surgery had the added benefit of programming adjustments to minimise stimulation-related complications. Permanent neurological complications were most commonly reported for RF thalamotomy. Thalamic DBS is an effective, safe treatment with a long history. For patients who are medically unfit or reluctant to undergo DBS, several thalamic lesioning methods have parallel benefits to unilateral DBS surgery. Each of these surgical modalities has its own nuance for treatment and patient selection. These factors should be carefully considered by both neurosurgeons and patients when selecting an appropriate treatment for ET. BMJ Publishing Group 2019-04 2018-10-18 /pmc/articles/PMC6581115/ /pubmed/30337440 http://dx.doi.org/10.1136/jnnp-2018-318240 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Movement Disorders Dallapiazza, Robert Francis Lee, Darrin J De Vloo, Philippe Fomenko, Anton Hamani, Clement Hodaie, Mojgan Kalia, Suneil K Fasano, Alfonso Lozano, Andres M Outcomes from stereotactic surgery for essential tremor |
title | Outcomes from stereotactic surgery for essential tremor |
title_full | Outcomes from stereotactic surgery for essential tremor |
title_fullStr | Outcomes from stereotactic surgery for essential tremor |
title_full_unstemmed | Outcomes from stereotactic surgery for essential tremor |
title_short | Outcomes from stereotactic surgery for essential tremor |
title_sort | outcomes from stereotactic surgery for essential tremor |
topic | Movement Disorders |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581115/ https://www.ncbi.nlm.nih.gov/pubmed/30337440 http://dx.doi.org/10.1136/jnnp-2018-318240 |
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