Objective: To identify clinical and technical predictors of recurrence of tremor in our own cohort of ET and TDPD patients undergoing Vim-FUS

Background: Vim-FUS improves tremor in medication-refractory TDPD and ET.Some patients may experience tremor relapse(TR) after Vim-FUS.The determining factors influencing have not been completely understood

Method: Retrospective study including TDPD and ET patients undergoing Vim-FUS and experiencing TR.TR was defined as initial tremor improvement>50% from baseline,followed by a reduction in this improvement to<50% at 6 months after Vim-FUS.Demographics,clinical features and procedure technical aspects were analysed.To assess tremor severity,MDS-UPDRS III was used in PD and CRST in ET

Results: Among 80TDPD and 215ET patients who received Vim-FUS for medication-refractory tremor,6(7.5%) and 13(6%),respectively,experienced TR.TR patients’ characteristics were compared with those of patients without TR in each group.

In the TDPD group,TR patients presented shorter disease evolution(median 2.5[2.0-4.0] ys vs 7.0[4.0-12.0],p<0.001) and tended to be younger(median age 67.0[63.0-71.0] vs 72.5[66.3-76.8],p=0.07),with no differences in other demographic or clinical characteristics at baseline.One month after Vim-FUS,although the median relative improvement in the TR group was higher than 50%(81.7%),it differed from that of the no-TR group,which showed 100% improvement(p=0.0469).Regarding technical aspects of the procedure,TR patients tended to have a larger skull area(361.0[353.5-371.5]cm2 vs 332.0[314.0- 354.0],p=0.08),with no other differences between groups.

In the ET group,TR patients tended to be older at baseline(median age 79.0[68.0- 82.0] vs 73.0[67.0-77.0],p=0.08).The median relative improvement in CRST A+B for the treated side 1month after Vim-FUS was 20% for TR patients vs 80% in non-TR(p<0.001).There were no other significant differences in baseline demographic characteristics or procedural technical aspects

Conclusion: TR after Vim-FUS occurred in a minority of patients at our centre.In both TDPD and ET cohorts,TR was associated with less robust tremor suppression at 1 month,suggesting that suboptimal early response may be a marker of later recurrence.In TDPD,TR was also associated with shorter disease duration and tended to occur in younger patients,although the small number of cases limits firm conclusions.No consistent associations with procedural technical parametres were identified

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MDS Abstracts - https://www.mdsabstracts.org/abstract/determinant-factor-of-tremor-recurrence-after-vim-fus-in-et-and-tremor-dominant-pd/