scholarly journals Treatment of a Patient With Task-Specific Writing Tremor Using Magnetic Resonance-Guided Focused Ultrasound

2018 ◽  
Vol 45 (4) ◽  
pp. 474-477 ◽  
Author(s):  
Ying Meng ◽  
Suganth Suppiah ◽  
Nadia Scantlebury ◽  
Nir Lipsman ◽  
Michael L. Schwartz
Keyword(s):  
Magnetic Resonance ◽  
Clinical Improvement ◽  
Focused Ultrasound ◽  
Symptomatic Relief ◽  
Body Part ◽  
Incremental Benefit ◽  
Writer’S Cramp ◽  
Writer's Cramp ◽  
Repetitive Movements

AbstractTask-specific dystonia is characterized by abnormal repetitive movements or postures in a specific body part that is triggered and ends with a task, such as writing. Failing medications, surgery, specifically disruption of key nuclei in the thalamus, can provide excellent symptomatic relief. Transcranial magnetic resonance (MR)-guided focused ultrasound is an emerging incision-less thermoablation technique. We describe MR-guided focused ultrasound tandem ablation of the ventral intermediate and ventralis oralis posterior nuclei in a 60-year-old patient with writer’s cramp. The clinical improvement was immediate with incremental benefit from the latter lesion, which was sustained at 6 months follow-up.

Writer's Cramp: a Controlled Trial of Habit Reversal Treatment

1988 ◽  
Vol 153 (1) ◽  
pp. 111-115 ◽  
Author(s):  
Angelika Wieck ◽  
Richard Harrington ◽  
Isaac Marks ◽  
Colin Marsden
Keyword(s):  
Relaxation Training ◽  
Controlled Trial ◽  
Control Treatment ◽  
Controlled Study ◽  
Habit Reversal ◽  
Reversal Training ◽  
Writer’S Cramp ◽  
Writer's Cramp ◽  
Habit Reversal Training

In uncontrolled studies, several behavioural methods, including habit reversal, were said to be useful in writer's cramp. In this controlled study, 23 subjects with writer's cramp recruited from a neurology clinic were randomly allocated to five sessions over four weeks of either habit reversal training or a control treatment of relaxation training. Three subjects dropped out. Twenty patients (9 habit reversers, 11 controls) completed the trial up to three months follow-up. Outcome measures included observation of writing within the session, assessment of writing tasks completed at home, and blind ratings by an independent assessor. The results showed that habit reversal was no better than relaxation. Taking both treatments together, patients improved to three months follow-up on seven of nine measures, but remained substantially handicapped.

scholarly journals Preliminary experience with a transcranial magnetic resonance–guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson’s disease

2018 ◽  
Vol 44 (2) ◽  
pp. E7 ◽  
Author(s):  
Domenico Gerardo Iacopino ◽  
Cesare Gagliardo ◽  
Antonella Giugno ◽  
Giuseppe Roberto Giammalva ◽  
Alessandro Napoli ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Magnetic Resonance ◽  
Essential Tremor ◽  
Focused Ultrasound ◽  
Ultrasound Surgery ◽  
Focused Ultrasound Surgery ◽  
Stereotactic Frame ◽  
Clinical Series

OBJECTIVETranscranial magnetic resonance–guided focused ultrasound surgery (tcMRgFUS) is one of the emerging noninvasive technologies for the treatment of neurological disorders such as essential tremor (ET), idiopathic asymmetrical tremor-dominant Parkinson’s disease (PD), and neuropathic pain. In this clinical series the authors present the preliminary results achieved with the world’s first tcMRgFUS system integrated with a 1.5-T MRI unit.METHODSThe authors describe the results of tcMRgFUS in a sample of patients with ET and with PD who underwent the procedure during the period from January 2015 to September 2017. A monolateral ventralis intermedius nucleus (VIM) thalamic ablation was performed in both ET and PD patients. In all the tcMRgFUS treatments, a 1.5-T MRI scanner was used for both planning and monitoring the procedure.RESULTSDuring the study period, a total of 26 patients underwent tcMRgFUS thalamic ablation for different movement disorders. Among these patients, 18 were diagnosed with ET and 4 were affected by PD. All patients with PD were treated using tcMRgFUS thalamic ablation and all completed the procedure. Among the 18 patients with ET, 13 successfully underwent tcMRgFUS, 4 aborted the procedure during ultrasound delivery, and 1 did not undergo the tcMRgFUS procedure after stereotactic frame placement. Two patients with ET were not included in the results because of the short follow-up duration at the time of this study. A monolateral VIM thalamic ablation in both ET and PD patients was performed. All the enrolled patients were evaluated before the treatment and 2 days after, with a clinical control of the treatment effectiveness using the graphic items of the Fahn-Tolosa-Marin tremor rating scale. A global reevaluation was performed 3 months (17/22 patients) and 6 months (11/22 patients) after the treatment; the reevaluation consisted of clinical questionnaires, neurological tests, and video recordings of the tests. All the ET and PD treated patients who completed the procedure showed an immediate amelioration of tremor severity, with no intra- or posttreatment severe permanent side effects.CONCLUSIONSAlthough this study reports on a small number of patients with a short follow-up duration, the tcMRgFUS procedure using a 1.5-T MRI unit resulted in a safe and effective treatment option for motor symptoms in patients with ET and PD. To the best of the authors’ knowledge, this is the first clinical series in which thalamotomy was performed using tcMRgFUS integrated with a 1.5-T magnet.

scholarly journals Magnetic Resonance-guided Focused Ultrasound Treatment for Uterine Fibroids: First Study in Indian Women

2012 ◽  
Vol 2 ◽  
pp. 74 ◽  
Author(s):  
Shrinivas B. Desai ◽  
Abhijit A. Patil ◽  
Rahul Nikam ◽  
Ajinkya S. Desai ◽  
Vrushali Bachhav
Keyword(s):  
Magnetic Resonance ◽  
Adverse Events ◽  
Focused Ultrasound ◽  
Uterine Fibroids ◽  
Ultrasound Surgery ◽  
Indian Women ◽  
Safety And Efficacy ◽  
Focused Ultrasound Surgery ◽  
The Mean

Objectives: To study the results of magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment carried out on Indian patients in our Hospital. Materials and Methods: Fifty Indian women (mean age = 36.2 ± 8.3 years) were treated for fibroids as outpatients using the ExAblate MRgFUS system (InSightec). Non-perfused volumes (NPVs) were measured immediately after treatment to calculate the treatment outcomes. A validated symptom-specific questionnaire to record their symptoms prior to treatment and six months following treatment was completed by patients. The size of the fibroids was measured on the day of the treatment and during the 6-month checkup to calculate shrinkage. Adverse events during and following treatment were recorded and monitored. Results: The average NPV ratio measured after the treatment was 88% ± 6%, indicative of high ablated fibroid tissue. Prior to treatment, the mean Symptoms Severity Score was 56.9 ± 4.8 (n = 50), which is indicative of highly symptomatic patients. Six months following treatment, there was an average fibroid shrinkage of 30% ± 11%, and a significant decrease in the mean score to 28.6 ± 6.0 (n = 50) (P < 0.001). There were no reports of serious or unexpected adverse events at any point during treatment or during the follow-up period from any of the 50 women treated in the current study. Conclusions: The current results obtained after 6 months of treatment corroborated previous data on the safety and efficacy of MRgFUS for treating uterine fibroids. This is the first publication that provides such data for a large cohort of Indian women.

Technical and operative factors affecting magnetic resonance imaging–guided focused ultrasound thalamotomy for essential tremor: experience from 250 treatments

2021 ◽  
pp. 1-9
Author(s):  
Myung Ji Kim ◽  
So Hee Park ◽  
Kyung Won Chang ◽  
Yuhee Kim ◽  
Jing Gao ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multivariate Analysis ◽  
Magnetic Resonance ◽  
Low Temperature ◽  
Essential Tremor ◽  
Focused Ultrasound ◽  
Rating Scale ◽  
Resonance Imaging ◽  
Temperature Group

OBJECTIVE Magnetic resonance imaging–guided focused ultrasound (MRgFUS) provides real-time monitoring of patients to assess tremor control and document any adverse effects. MRgFUS of the ventral intermediate nucleus (VIM) of the thalamus has become an effective treatment option for medically intractable essential tremor (ET). The aim of this study was to analyze the correlations of clinical and technical parameters with 12-month outcomes after unilateral MRgFUS thalamotomy for ET to help guide future clinical treatments. METHODS From October 2013 to January 2019, data on unilateral MRgFUS thalamotomy from the original pivotal study and continued-access studies from three different geographic regions were collected. Authors of the present study retrospectively reviewed those data and evaluated the efficacy of the procedure on the basis of improvement in the Clinical Rating Scale for Tremor (CRST) subscore at 1 year posttreatment. Safety was based on the rates of moderate and severe thalamotomy-related adverse events. Treatment outcomes in relation to various patient- and sonication-related parameters were analyzed in a large cohort of patients with ET. RESULTS In total, 250 patients were included in the present analysis. Improvement was sustained throughout the 12-month follow-up period, and 184 (73.6%) of 250 patients had minimal or no disability due to tremor (CRST subscore < 10) at the 12-month follow-up. Younger age and higher focal temperature (Tmax) correlated with tremor improvement in the multivariate analysis (OR 0.948, p = 0.013; OR 1.188, p = 0.025; respectively). However, no single statistically significant factor correlated with Tmax in the multivariate analysis. The cutoff value of Tmax in predicting a CRST subscore < 10 was 55.8°C. Skull density ratio (SDR) was positively correlated with heating efficiency (β = 0.005, p < 0.001), but no significant relationship with tremor improvement was observed. In the low-temperature group, 1–3 repetitions to the right target with 52°C ≤ Tmax ≤ 54°C was sufficient to generate sustained tremor suppression within the investigated follow-up period. The high-temperature group had a higher rate of balance disturbances than the low-temperature group (p = 0.04). CONCLUSIONS The authors analyzed the data of 250 patients with the aim of improving practices for patient screening and determining treatment endpoints. These results may improve the safety, efficacy, and efficiency of MRgFUS thalamotomy for ET.

scholarly journals Transcranial magnetic resonance imaging–guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain

2012 ◽  
Vol 32 (1) ◽  
pp. E1 ◽  
Author(s):  
Daniel Jeanmonod ◽  
Beat Werner ◽  
Anne Morel ◽  
Lars Michels ◽  
Eyal Zadicario ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Neuropathic Pain ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Real Time ◽  
Focused Ultrasound ◽  
Resonance Imaging ◽  
Mr Thermometry ◽  
Chronic Neuropathic Pain

Object Recent technological developments open the field of therapeutic application of focused ultrasound to the brain through the intact cranium. The goal of this study was to apply the new transcranial magnetic resonance imaging–guided focused ultrasound (tcMRgFUS) technology to perform noninvasive central lateral thalamotomies (CLTs) as a treatment for chronic neuropathic pain. Methods In 12 patients suffering from chronic therapy-resistant neuropathic pain, tcMRgFUS CLT was proposed. In 11 patients, precisely localized thermal ablations of 3–4 mm in diameter were produced in the posterior part of the central lateral thalamic nucleus at peak temperatures between 51°C and 64°C with the aid of real-time patient monitoring and MR imaging and MR thermometry guidance. The treated neuropathic pain syndromes had peripheral (5 patients) or central (6 patients) origins and covered all body parts (face, arm, leg, trunk, and hemibody). Results Patients experienced mean pain relief of 49% at the 3-month follow-up (9 patients) and 57% at the 1-year follow-up (8 patients). Mean improvement according to the visual analog scale amounted to 42% at 3 months and 41% at 1 year. Six patients experienced immediate and persisting somatosensory improvements. Somatosensory and vestibular clinical manifestations were always observed during sonication time because of ultrasound-based neuronal activation and/or initial therapeutic effects. Quantitative electroencephalography (EEG) showed a significant reduction in EEG spectral overactivities. Thermal ablation sites showed sharply delineated ellipsoidal thermolesions surrounded by short-lived vasogenic edema. Lesion reconstructions (18 lesions in 9 patients) demonstrated targeting precision within a millimeter for all 3 coordinates. There was 1 complication, a bleed in the target with ischemia in the motor thalamus, which led to the introduction of 2 safety measures, that is, the detection of a potential cavitation by a cavitation detector and the maintenance of sonication temperatures below 60°C. Conclusions The authors assert that tcMRgFUS represents a noninvasive, precise, and radiation-free neurosurgical technique for the treatment of neuropathic pain. The procedure avoids mechanical brain tissue shift and eliminates the risk of infection. The possibility of applying sonication thermal spots free from trajectory restrictions should allow one to optimize target coverage. The real-time continuous MR imaging and MR thermometry monitoring of targeting accuracy and thermal effects are major factors in optimizing precision, safety, and efficacy in an outpatient context.

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