Objective: This study aims at assessing safety and effectiveness of Magnetic Resonance-guided Focused High Intensity Ultrasound (MRgFUs) thalamotomy in elderly patients with essential and parkinsonian tremor.
Background: MRgFUs thalamotomy of the Vim nucleus is gaining importance as a treatment for resistant tremor in Parkinson’s disease and essential tremor patients, especially in elderly patients who are not eligible for the mainstay treatment (deep brain stimulation, DBS). However, there are no studies comparing safety and effectiveness in older patients and their younger counterparts.
Method: A cohort study of patients (51 with PD and 103 with ET) treated with MRgFUS thalamotomy was conducted. Follow-up visits were carried out at 1, 3 and 6-months after treatment. The outcome variables were the improvement percentage on CRST and UPDRS tremor scores, as well as treatment-related adverse effects (graded on a scale 0-4). A mixed model for repeated measures statistical analysis was used and 75 years was used as a cut-off point for age.
Results: ET patients had a mean age of 72.7 years. 60 patients <75-yo (mean age=66.6), and 43 patients ≥75-yo (mean age=81.2). Patients with PD had a mean age of 69.8 years. 34 patients were <75-yo (mean age = 65.6), while 17 were ≥75-yo (mean age =78.3). The percentages of improvement for CRST scores at month 1, 3 and 6 are visible in table 1, as well as improvement of PD total tremor. No statistically significant differences were found between the elderly and the younger group. Interestingly, tremor improvement was around 80% in both groups of ET patients. PD patients had similarly high improvement percentages.
The proportion of patients with some adverse effect at 1 month was 74.4% in the younger group vs 74.6 in the elderly group, and 28.8% vs 42.9% at 6 months. Most of these side effects were mild and the number of side effects that each patient had diminished over time, with most having between 0 and 1 mild adverse effects at the end of follow-up.
No statistically significant association was found between age and the presence (binomial variable, p=0.54) or number of adverse effects (numerical variable, p=0.51).
Conclusion: No statistically significant differences were found in this study for the association between age and a worse outcome in HIFU thalamotomy of the Vim. While this study cannot conclude equality, further studies could support such hypothesis.
To cite this abstract in AMA style:J. Carte-García, A. Gorospe, I. Avilés, A. Martín-Bastida, O. Parras, A. Arcadi, M. Fernández, L. González, J. Guridi, MC. Rodríguez-Oroz. Safety and effectiveness of unilateral MRgFUS thalamotomy in elderly patients with essential and parkinsonian tremor [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/safety-and-effectiveness-of-unilateral-mrgfus-thalamotomy-in-elderly-patients-with-essential-and-parkinsonian-tremor/. Accessed December 1, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/safety-and-effectiveness-of-unilateral-mrgfus-thalamotomy-in-elderly-patients-with-essential-and-parkinsonian-tremor/