A prospective study of MRI-guided focused ultrasound thalamotomy in essential tremor
Notice bibliographique
Résumé
Objective. To study the effect of magnetic resonance imaging-guided focused ultrasound (MR-FUS) on the motor and non-motor symptoms of essential tremor (ET) (cognitive functions, anxiety, depression, apathy, sleep disorders), as well as to establish association between adverse events (AEs) and the technical parameters of the surgery, postablation neuroimaging changes in the brain matter, and clinical and demographic factors. Material and methods. Twenty-two patients with disabling drug-resistant ET were prospectively evaluated prior to unilateral ventral intermediate nucleus (Vim) FUS thalamotomy, and at 24 hours, 3, 6, and 12 months postoperatively. The change of tremor was assessed using the Clinical Rating Scale for Tremor (CRST). Non-motor symptoms were assessed using the Montreal Cognitive Assessment (MoCA), the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), the Apathy Scale, and the Epworth Sleepiness Scale. The Tinetti test was used to assess balance and gait. The quality of life for patients with ET was assessed using the Quality of Life in Essential Tremor Questionnaire (QUEST). MRI with a magnetic field strength of 3.0 T was performed immediately after surgery, as well as at 24 hours, 3, 6, and 12 months post-surgery. Results. MR-FUS led to a significant reduction in tremor in the extremities of the contralateral thalamotomy site; the mean total CRST and hemi-CRST scores decreased by 78% and 80% (p<0.0001), respectively, with a significant persistence of the improvement at 12 months after surgery by 63% and 64% (p=0.012), respectively. The quality of life of patients with ET significantly improved at 6 and 12 months after surgery by 38% (p=0.017) and 45% (p=0.012), respectively. MR-FUS had no statistically significant impact on cognitive function, severity of apathy, anxiety, depression, or daytime sleepiness (p>0.05). Mild adverse events occurred in 45% of patients immediately after surgery, and most of the AEs regressed by Month 3 of follow-up. The lesion volume and postoperative edema were significantly correlated with a decrease in the total CRST score at 6 and 12 months postoperatively (r=–1, p=0.01). The results of the correlation analysis showed that patients with AEs after FUS-thalamotomy had larger foci of necrosis and postoperative edema, and also had a significantly shorter duration of surgery (p=0.042). However, the number of sonications (both verification and therapeutic), the power of ultrasound waves, and the maximum exposure temperatures in the patients of the compared groups did not differ significantly. Conclusion. The results of an open prospective study confirmed the effectiveness of unilateral FUS thalamotomy of the Vim nucleus of the thalamus for the treatment of ET. There was no significant effect on the non-motor manifestations of ET. All reported AEs were mild and transient. The risk of AEs was determined by the volume of the lesion and postoperative edema, as well as the duration of surgery.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».