Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience
Introduction: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-domin...
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| Format: | Article |
| Language: | English |
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Elsevier España
2023-04-01
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| Series: | Neurología (English Edition) |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2173580822000232 |
| _version_ | 1797847316186529792 |
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| author | J.R. Pérez-Sánchez R. Martínez-Álvarez N.E. Martínez Moreno C. Torres Diaz G. Rey I. Pareés A. Del Barrio A. J. Álvarez-Linera M.M. Kurtis |
| author_facet | J.R. Pérez-Sánchez R. Martínez-Álvarez N.E. Martínez Moreno C. Torres Diaz G. Rey I. Pareés A. Del Barrio A. J. Álvarez-Linera M.M. Kurtis |
| author_sort | J.R. Pérez-Sánchez |
| collection | DOAJ |
| description | Introduction: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. Methods: We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months’ follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. Results: Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. Conclusions: This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants. Resumen: Introducción: La radiocirugía estereotáctica con Gamma Knife® (GK), sobre el núcleo ventral intermedio-medial del tálamo (VIM), unilateral es una opción neuroquirúrgica mínimamente invasiva para el temblor refractario. Se describe la experiencia de talamotomía con GK (TGK) en pacientes con temblor esencial (TE) y enfermedad de Parkinson (EP) de predominio tremórico de una unidad especializada en cirugía estereotáctica. Métodos: Se revisan los pacientes tratados con TGK desde enero de 2014 hasta febrero de 2018. Se analizan variables clínico-demográficas, indicación, dosis empleada, eficacia (mediante subescalas de Fahn-Tolosa-Marin (FTM) y MDS-UPDRS motora) y efectos adversos (EA). Resultados: Se registraron 13 pacientes, seis con diagnóstico de EP de predominio tremórico, cuatro con TE refractario y tres casos de TE + EP. La mediana de edad fue 78 años (62-83), con siete pacientes > 75 años. Cuatro pacientes anticoagulados y dos con antecedentes de ictus previo. La dosis máxima de radiación aplicada fue 130 Gy. La media de seguimiento fue 30,0 (14,5) meses. Se observó una mejoría significativa del temblor en las subescalas de FTM del 63,6% a 12 meses y del 63,5% al final del seguimiento y en items de temblor de MDS-UPDRS del 71,3% a 12 meses y del 60,3% al final del seguimiento. Once pacientes refirieron mejoría significativa en su calidad de vida. Tres pacientes refirieron EA leves y transitorios. Conclusiones: Se presenta la mayor serie de pacientes con TE y parkinsoniano tratados con TGK en España con seguimiento a largo plazo. La TGK puede ser un tratamiento seguro y con eficacia mantenida en temblor refractario, incluso en edad avanzada o en tratamiento anticoagulante. |
| first_indexed | 2024-04-09T18:09:18Z |
| format | Article |
| id | doaj.art-ba4c99739dbe48d6bbc92ff4b135181e |
| institution | Directory Open Access Journal |
| issn | 2173-5808 |
| language | English |
| last_indexed | 2024-04-09T18:09:18Z |
| publishDate | 2023-04-01 |
| publisher | Elsevier España |
| record_format | Article |
| series | Neurología (English Edition) |
| spelling | doaj.art-ba4c99739dbe48d6bbc92ff4b135181e2023-04-14T04:19:03ZengElsevier EspañaNeurología (English Edition)2173-58082023-04-01383188196Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experienceJ.R. Pérez-Sánchez0R. Martínez-Álvarez1N.E. Martínez Moreno2C. Torres Diaz3G. Rey4I. Pareés5A. Del Barrio A.6J. Álvarez-Linera7M.M. Kurtis8Unidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ruber Internacional, Madrid, SpainServicio de Radiocirugía y Neurocirugía funcional, Hospital Ruber Internacional, Madrid, SpainServicio de Radiocirugía y Neurocirugía funcional, Hospital Ruber Internacional, Madrid, SpainServicio de Radiocirugía y Neurocirugía funcional, Hospital Ruber Internacional, Madrid, Spain; Servicio de Neurocirugía, Hospital Universitario de la Princesa, Madrid, SpainServicio de Radiocirugía y Neurocirugía funcional, Hospital Ruber Internacional, Madrid, SpainUnidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ruber Internacional, Madrid, SpainUnidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ruber Internacional, Madrid, SpainServicio de Radiología, Hospital Ruber Internacional, Madrid, SpainUnidad de Trastornos del Movimiento, Servicio de Neurología, Hospital Ruber Internacional, Madrid, Spain; Corresponding author.Introduction: Unilateral Gamma Knife™ stereotactic radiosurgery on the ventral-intermediate nucleus of the thalamus is a minimally invasive neurosurgical option for refractory tremor. We describe the experience of Gamma Knife™ thalamotomy (GKT) in patients with essential tremor (ET) and tremor-dominant Parkinson's disease (PD) at our specialised stereotactic neurosurgery unit. Methods: We reviewed the cases of patients treated with GKT between January 2014 and February 2018 with a minimum of 12 months’ follow-up. We analysed clinical and demographic variables, indication, radiation dose, effectiveness (based on subscales of the Fahn-Tolosa-Marin [FTM] scale and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale [MDS-UPDRS] motor score), and adverse events. Results: Thirteen patients were registered, 6 with a diagnosis of tremor-dominant PD, four with refractory ET, and three with ET and PD. Median age was 78 years (range, 62-83), with seven patients aged over 75 years. Four patients were receiving anticoagulants and two had history of stroke. The maximum radiation dose administered was 130 Gy. Mean (standard deviation) follow-up duration was 30.0 (14.5) months. Significant tremor improvement was observed on the FTM subscales: 63.6% at 12 months and 63.5% at the end of follow-up; MDS-UPDRS tremor items showed improvements of 71.3% at 12 months and 60.3% at the end of follow up. Eleven patients reported significant improvements in quality of life, and 3 reported mild and transient adverse effects. Conclusions: This is the largest series of patients with essential and parkinsonian tremor treated with GKT and followed up in the long term in Spain. GKT can be safe and effective in the long term in patients with refractory tremor, including in elderly patients and those receiving anticoagulants. Resumen: Introducción: La radiocirugía estereotáctica con Gamma Knife® (GK), sobre el núcleo ventral intermedio-medial del tálamo (VIM), unilateral es una opción neuroquirúrgica mínimamente invasiva para el temblor refractario. Se describe la experiencia de talamotomía con GK (TGK) en pacientes con temblor esencial (TE) y enfermedad de Parkinson (EP) de predominio tremórico de una unidad especializada en cirugía estereotáctica. Métodos: Se revisan los pacientes tratados con TGK desde enero de 2014 hasta febrero de 2018. Se analizan variables clínico-demográficas, indicación, dosis empleada, eficacia (mediante subescalas de Fahn-Tolosa-Marin (FTM) y MDS-UPDRS motora) y efectos adversos (EA). Resultados: Se registraron 13 pacientes, seis con diagnóstico de EP de predominio tremórico, cuatro con TE refractario y tres casos de TE + EP. La mediana de edad fue 78 años (62-83), con siete pacientes > 75 años. Cuatro pacientes anticoagulados y dos con antecedentes de ictus previo. La dosis máxima de radiación aplicada fue 130 Gy. La media de seguimiento fue 30,0 (14,5) meses. Se observó una mejoría significativa del temblor en las subescalas de FTM del 63,6% a 12 meses y del 63,5% al final del seguimiento y en items de temblor de MDS-UPDRS del 71,3% a 12 meses y del 60,3% al final del seguimiento. Once pacientes refirieron mejoría significativa en su calidad de vida. Tres pacientes refirieron EA leves y transitorios. Conclusiones: Se presenta la mayor serie de pacientes con TE y parkinsoniano tratados con TGK en España con seguimiento a largo plazo. La TGK puede ser un tratamiento seguro y con eficacia mantenida en temblor refractario, incluso en edad avanzada o en tratamiento anticoagulante.http://www.sciencedirect.com/science/article/pii/S2173580822000232RadiocirugíaGamma KnifeTemblor esencialEnfermedad de ParkinsonTalamotomía |
| spellingShingle | J.R. Pérez-Sánchez R. Martínez-Álvarez N.E. Martínez Moreno C. Torres Diaz G. Rey I. Pareés A. Del Barrio A. J. Álvarez-Linera M.M. Kurtis Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience Neurología (English Edition) Radiocirugía Gamma Knife Temblor esencial Enfermedad de Parkinson Talamotomía |
| title | Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience |
| title_full | Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience |
| title_fullStr | Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience |
| title_full_unstemmed | Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience |
| title_short | Gamma Knife® stereotactic radiosurgery as a treatment for essential and parkinsonian tremor: long-term experience |
| title_sort | gamma knife r stereotactic radiosurgery as a treatment for essential and parkinsonian tremor long term experience |
| topic | Radiocirugía Gamma Knife Temblor esencial Enfermedad de Parkinson Talamotomía |
| url | http://www.sciencedirect.com/science/article/pii/S2173580822000232 |
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