Comparison between deep brain stimulation and magnetic resonance-guided focused ultrasound in the treatment of essential tremor: a systematic review and pooled analysis of functional outcomes.

Giordano, M ; Caccavella, VM ; et al.

In: Journal of neurology, neurosurgery, and psychiatry, Jg. 91 (2020-12-01), Heft 12, S. 1270-1278

academicJournal

The current gold standard surgical treatment for medication-resistant essential tremor (ET) is deep brain stimulation (DBS). However, recent advances in technologies have led to the development of incisionless techniques, such as magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy. The authors perform a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to compare unilateral MRgFUS thalamotomy to unilateral and bilateral DBS in the treatment of ET in terms of tremor severity and quality of life improvement. PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and SCOPUS databases were searched. 45 eligible articles, published between 1990 and 2019, were retrieved. 1202 patients were treated with DBS and 477 were treated with MRgFUS thalamotomy. Postoperative tremor improvement was greater following DBS than MRgFUS thalamotomy (p<0.001). A subgroup analysis was carried out stratifying by treatment laterality: bilateral DBS was significantly superior to both MRgFUS and unilateral DBS (p<0.001), but no significant difference was recorded between MRgFUS and unilateral DBS (p<0.198). Postoperative quality of life improvement was significantly greater following MRgFUS thalamotomy than DBS (p<0.001). Complications were differently distributed among the two groups (p<0.001). Persistent complications were significantly more common in the MRgFUS group (p=0.042). While bilateral DBS proves superior to unilateral MRgFUS thalamotomy in the treatment of ET, a subgroup analysis suggests that treatment laterality is the most significant determinant of tremor improvement, thus highlighting the importance of future investigations on bilateral staged MRgFUS thalamotomy.

Competing Interests: Competing interests: None declared.

Titel:	Comparison between deep brain stimulation and magnetic resonance-guided focused ultrasound in the treatment of essential tremor: a systematic review and pooled analysis of functional outcomes.
Autor/in / Beteiligte Person:	Giordano, M ; Caccavella, VM ; Zaed, I ; Foglia Manzillo, L ; Montano, N ; Olivi, A ; Polli, FM
Zeitschrift:	Journal of neurology, neurosurgery, and psychiatry, Jg. 91 (2020-12-01), Heft 12, S. 1270-1278
Veröffentlichung:	London : BMJ Publishing Group ; <i>Original Publication</i>: London : British Medical Association, 2020
Medientyp:	academicJournal
ISSN:	1468-330X (electronic)
DOI:	10.1136/jnnp-2020-323216
Schlagwort:	Essential Tremor physiopathology Gait Disorders, Neurologic epidemiology Gait Disorders, Neurologic physiopathology Humans Hypesthesia epidemiology Hypesthesia physiopathology Implantable Neurostimulators Magnetic Resonance Imaging Neurosurgical Procedures Paresthesia epidemiology Paresthesia physiopathology Postoperative Complications epidemiology Postoperative Complications physiopathology Prosthesis Implantation Speech Disorders epidemiology Speech Disorders physiopathology Surgery, Computer-Assisted Thalamus surgery Treatment Outcome Deep Brain Stimulation methods Essential Tremor therapy High-Intensity Focused Ultrasound Ablation methods
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Comparative Study; Journal Article; Meta-Analysis; Systematic Review Language: English [J Neurol Neurosurg Psychiatry] 2020 Dec; Vol. 91 (12), pp. 1270-1278. <i>Date of Electronic Publication: </i>2020 Oct 14. MeSH Terms: Deep Brain Stimulation / methods ; Essential Tremor / therapy ; High-Intensity Focused Ultrasound Ablation / *methods ; Essential Tremor / physiopathology ; Gait Disorders, Neurologic / epidemiology ; Gait Disorders, Neurologic / physiopathology ; Humans ; Hypesthesia / epidemiology ; Hypesthesia / physiopathology ; Implantable Neurostimulators ; Magnetic Resonance Imaging ; Neurosurgical Procedures ; Paresthesia / epidemiology ; Paresthesia / physiopathology ; Postoperative Complications / epidemiology ; Postoperative Complications / physiopathology ; Prosthesis Implantation ; Speech Disorders / epidemiology ; Speech Disorders / physiopathology ; Surgery, Computer-Assisted ; Thalamus / surgery ; Treatment Outcome Contributed Indexing: Keywords: movement disorders; surgery; systematic reviews; tremor; ultrasound Entry Date(s): Date Created: 20201015 Date Completed: 20210322 Latest Revision: 20210322 Update Code: 20240513

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