Effects on Gait and Balance of VIM Gamma Knife Radiosurgery in Essential Tremor.

IF 1.9 4区医学 Q3 NEUROIMAGING

Stereotactic and Functional Neurosurgery Pub Date : 2024-01-01 Epub Date: 2024-08-21 DOI:10.1159/000539812

Valentin Mira, Babette Zwaard, Emmanuelle Boutin, Etienne Guillaud, Axelle Cretol, Jean Régis, Jean-Philippe Azulay, Tatiana Witjas, Marianne Vaugoyeau

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Abstract

Introduction: Essential tremor (ET) is the most common movement disorder, characterized by an action tremor in the upper limbs. Neurosurgical techniques targeting the thalamic ventrointermediate nucleus (VIM) including thermocoagulation demonstrated a potential risk for gait and posture worsening. This study evaluates the potential effect of VIM Gamma Knife radiosurgery (GKR) in ET on gait and posture performances.

Methods: We conducted a prospective study to quantitatively assess gait and balance in severe ET patients before and 1 year after unilateral GKR. Seventy-three patients were included in this series.

Results: First, we confirmed the unilateral GKR efficacy in severe ET patients: global tremor score and impairments in activities of daily living improved, respectively, by 67% and 71.7%. The global gait and posture analysis found no significant differences before and 1 year after GKR. Three patients (4.1%) developed mild to moderate gait and posture impairment with proprioceptive ataxia. All of these AEs were induced by a hyper-response to radiosurgery.

Conclusions: Gait and posture performances were not statistically significant at the population. Nevertheless, gait and posture worsened in 4% of patients after GKR, all in the setting of hyper-response. This study shows that GKR may be a safe neurosurgical alternative to improve ADL in a population of patients with TE.

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VIM伽玛刀放射外科手术对重度震颤患者步态和平衡的影响

简介本质性震颤（ET）是最常见的运动障碍，以上肢动作性震颤为特征。针对丘脑室间核（VIM）的神经外科技术，包括热凝术，显示出步态和姿势恶化的潜在风险。本研究评估了 ET 中 VIM 伽马刀放射外科手术（GKR）对步态和姿势表现的潜在影响：我们进行了一项前瞻性研究，定量评估重度 ET 患者在单侧 GKR 术前和术后 1 年的步态和平衡能力。结果：首先，我们证实了单侧 GKR 对重度 ET 患者步态和姿势的影响：首先，我们证实了单侧 GKR 对重度 ET 患者的疗效：总体震颤评分和日常生活障碍分别改善了 67% 和 71.7%。整体步态和姿势分析发现，GKR 前和 GKR 后 1 年无显著差异。三名患者（4.1%）出现了轻度至中度步态和姿势障碍，并伴有本体感觉共济失调。所有这些AE都是由放射手术的过度反应引起的：结论：步态和姿势的表现在人群中没有统计学意义。结论：步态和姿势表现在人群中没有统计学意义，但有 4% 的患者在 GKR 术后步态和姿势恶化，且都是在高反应的情况下。这项研究表明，GKR可能是一种安全的神经外科替代方法，可改善TE患者的ADL。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stereotactic and Functional Neurosurgery 医学-神经成像

CiteScore

3.80

自引率

0.00%

发文量

审稿时长

3 months

期刊介绍： ''Stereotactic and Functional Neurosurgery'' provides a single source for the reader to keep abreast of developments in the most rapidly advancing subspecialty within neurosurgery. Technological advances in computer-assisted surgery, robotics, imaging and neurophysiology are being applied to clinical problems with ever-increasing rapidity in stereotaxis more than any other field, providing opportunities for new approaches to surgical and radiotherapeutic management of diseases of the brain, spinal cord, and spine. Issues feature advances in the use of deep-brain stimulation, imaging-guided techniques in stereotactic biopsy and craniotomy, stereotactic radiosurgery, and stereotactically implanted and guided radiotherapeutics and biologicals in the treatment of functional and movement disorders, brain tumors, and other diseases of the brain. Background information from basic science laboratories related to such clinical advances provides the reader with an overall perspective of this field. Proceedings and abstracts from many of the key international meetings furnish an overview of this specialty available nowhere else. ''Stereotactic and Functional Neurosurgery'' meets the information needs of both investigators and clinicians in this rapidly advancing field.