{
    "abstract": "Unilateral magnetic resonance-guided focused ultrasound ablation of ventralis intermedius nucleus of the thalamus for essential tremor reduces tremor on 1 side, but untreated contralateral or midline symptoms remain limiting for some patients. Historically, bilateral lesioning produced unacceptable risks and was supplanted by deep brain stimulation; increasing acceptance of unilateral focused ultrasound lesioning has led to interest in a bilateral option.\nTo evaluate the safety and efficacy of staged, bilateral focused ultrasound thalamotomy.\nThis prospective, open-label, multicenter trial treated patients with essential tremor from July 2020 to October 2021, with a 12-month follow-up, at 7 US academic medical centers. Of 62 enrolled patients who had undergone unilateral focused ultrasound thalamotomy at least 9 months prior to enrollment, 11 were excluded and 51 were treated. Eligibility criteria included patient age (22 years and older), medication refractory, tremor severity (Clinical Rating Scale for Tremor [CRST] part A score \u22652 for postural or kinetic tremor), and functional disability (CRST part C score \u22652 in any category).\nA focused ultrasound system interfaced with magnetic resonance imaging allowed real-time alignment of thermography maps with anatomy. Subthreshold sonications allowed target interrogation for efficacy and off-target effects before creating an ablation.\nTremor/motor score (CRST parts A and B) at 3 months for the treated side after treatment was the primary outcome measure, and secondary assessments for efficacy and safety continued to 12 months.\nThe mean (SD) population age was 73 (13.9) years, and 44 participants (86.3%) were male. The mean (SD) tremor/motor score improved from 17.4 (5.4; 95% CI, 15.9-18.9) to 6.4 (5.3; 95% CI, 4.9 to 7.9) at 3 months (66% improvement in CRST parts A and B scores; 95% CI, 59.8-72.2; P\u2009<\u2009.001). There was significant improvement in mean (SD) postural tremor (from 2.5 [0.8]; 95% CI, 2.3 to 2.7 to 0.6 [0.9]; 95% CI, 0.3 to 0.8; P\u2009<\u2009.001) and mean (SD) disability score (from 10.3 [4.7]; 95% CI, 9.0-11.6 to 2.2 [2.8]; 95% CI, 1.4-2.9; P\u2009<\u2009.001). Twelve participants developed mild (study-defined) ataxia, which persisted in 6 participants at 12 months. Adverse events (159 of 188 [85%] mild, 25 of 188 [13%] moderate, and 1 severe urinary tract infection) reported most commonly included numbness/tingling (n\u2009=\u200917 total; n\u2009=\u20098 at 12 months), dysarthria (n\u2009=\u200915 total; n\u2009=\u20097 at 12 months), ataxia (n\u2009=\u200912 total; n\u2009=\u20096 at 12 months), unsteadiness/imbalance (n\u2009=\u200910 total; n\u2009=\u20090 at 12 months), and taste disturbance (n\u2009=\u20097 total; n\u2009=\u20093 at 12 months). Speech difficulty, including phonation, articulation, and dysphagia, were generally mild (rated as not clinically significant, no participants with worsening in all 3 measures) and transient.\nStaged, bilateral focused ultrasound thalamotomy significantly reduced tremor severity and functional disability scores. Adverse events for speech, swallowing, and ataxia were mostly mild and transient.\nClinicalTrials.gov Identifier NCT04112381.",
    "authors": [
        {
            "affiliation": "Department of Neurological Surgery, Weill Cornell Medicine, New York, New York.",
            "firstname": "Michael G",
            "initials": "MG",
            "lastname": "Kaplitt"
        },
        {
            "affiliation": "Department of Neurosurgery, University of North Carolina, Chapel Hill.",
            "firstname": "Vibhor",
            "initials": "V",
            "lastname": "Krishna"
        },
        {
            "affiliation": "Department of Neurosurgery, University of Maryland, Baltimore.",
            "firstname": "Howard M",
            "initials": "HM",
            "lastname": "Eisenberg"
        },
        {
            "affiliation": "Department of Neurosurgery, University of Virginia, Charlottesville.",
            "firstname": "W Jeffrey",
            "initials": "WJ",
            "lastname": "Elias"
        },
        {
            "affiliation": "Department of Radiology, Stanford University, Stanford, California.",
            "firstname": "Pejman",
            "initials": "P",
            "lastname": "Ghanouni"
        },
        {
            "affiliation": "Columbia University, New York, New York.",
            "firstname": "Gordon H",
            "initials": "GH",
            "lastname": "Baltuch"
        },
        {
            "affiliation": "Department of Neurosurgery, West Virginia University, Morgantown.",
            "firstname": "Ali",
            "initials": "A",
            "lastname": "Rezai"
        },
        {
            "affiliation": "Department of Neurosurgery, University of Pennsylvania, Philadelphia.",
            "firstname": "Casey H",
            "initials": "CH",
            "lastname": "Halpern"
        },
        {
            "affiliation": "Department of Neurosurgery, The Ohio State University, Columbus.",
            "firstname": "Brian",
            "initials": "B",
            "lastname": "Dalm"
        },
        {
            "affiliation": "Department of Neurology, University of Maryland, Baltimore.",
            "firstname": "Paul S",
            "initials": "PS",
            "lastname": "Fishman"
        },
        {
            "affiliation": "Department of Neurosurgery, Stanford University, Stanford, California.",
            "firstname": "Vivek P",
            "initials": "VP",
            "lastname": "Buch"
        },
        {
            "affiliation": "Department of Neurosurgery, University of Virginia, Charlottesville.",
            "firstname": "Shayan",
            "initials": "S",
            "lastname": "Moosa"
        },
        {
            "affiliation": "Department of Neurology, Cornell University, New York, New York.",
            "firstname": "Harini",
            "initials": "H",
            "lastname": "Sarva"
        },
        {
            "affiliation": "Department of Neurology, West Virginia University, Morgantown.",
            "firstname": "Ann Marie",
            "initials": "AM",
            "lastname": "Murray"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1001/jamaneurol.2024.2295\n10.5334/tohm.632\n10.1056/NEJM200002173420703\n10.1016/S0090-3019(97)00459-X\n10.1056/NEJMoa1600159\n10.1016/j.parkreldis.2017.03.017\n10.1002/mds.27401\n10.1159/000518662\n10.1002/mds.28716\n10.1136/jnnp-2020-325278\n10.1002/mds.26924\n10.3171/2017.4.JNS162803\n10.1093/neuros/nyy020\n10.1002/mds.21412\n10.1007/s00455-011-9336-2\n10.1111/j.1532-5415.2005.53221.x\n10.1093/sleep/14.6.540\n10.1080/14737175.2020.1737017\n10.1016/S1042-3680(18)30477-7\n10.1093/neuros/nyz417\n10.5334/tohm.757\n10.1056/NEJMoa2202721\n10.1136/jnnp-2014-307642",
    "journal": "JAMA neurology",
    "keywords": [],
    "methods": null,
    "publication_date": "2024-07-29",
    "pubmed_id": "39073822\n34277141\n10675426\n9457264\n27557301\n28400200\n29701263\n34515233\n34288097\n33906933\n28124434\n29053074\n29579287\n17343274\n21424584\n15817019\n1798888\n32116065\n7696875\n31690945\n37152623\n36812432\n24876191",
    "results": "The mean (SD) population age was 73 (13.9) years, and 44 participants (86.3%) were male. The mean (SD) tremor/motor score improved from 17.4 (5.4; 95% CI, 15.9-18.9) to 6.4 (5.3; 95% CI, 4.9 to 7.9) at 3 months (66% improvement in CRST parts A and B scores; 95% CI, 59.8-72.2; P\u2009<\u2009.001). There was significant improvement in mean (SD) postural tremor (from 2.5 [0.8]; 95% CI, 2.3 to 2.7 to 0.6 [0.9]; 95% CI, 0.3 to 0.8; P\u2009<\u2009.001) and mean (SD) disability score (from 10.3 [4.7]; 95% CI, 9.0-11.6 to 2.2 [2.8]; 95% CI, 1.4-2.9; P\u2009<\u2009.001). Twelve participants developed mild (study-defined) ataxia, which persisted in 6 participants at 12 months. Adverse events (159 of 188 [85%] mild, 25 of 188 [13%] moderate, and 1 severe urinary tract infection) reported most commonly included numbness/tingling (n\u2009=\u200917 total; n\u2009=\u20098 at 12 months), dysarthria (n\u2009=\u200915 total; n\u2009=\u20097 at 12 months), ataxia (n\u2009=\u200912 total; n\u2009=\u20096 at 12 months), unsteadiness/imbalance (n\u2009=\u200910 total; n\u2009=\u20090 at 12 months), and taste disturbance (n\u2009=\u20097 total; n\u2009=\u20093 at 12 months). Speech difficulty, including phonation, articulation, and dysphagia, were generally mild (rated as not clinically significant, no participants with worsening in all 3 measures) and transient.",
    "title": "Safety and Efficacy of Staged, Bilateral Focused Ultrasound Thalamotomy in Essential Tremor: An Open-Label Clinical Trial.",
    "xml": "<Element 'PubmedArticle' at 0x788502a77100>"
}