Magnetic resonance-guided focused ultrasound for essential tremor patients with low skull density ratio: A systematic review and meta-analysis.

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY

Parkinsonism & related disorders Pub Date : 2025-06-27 DOI:10.1016/j.parkreldis.2025.107936

Júlia Dos Santos Monteiro, Rafael Reis de Oliveira, Ocílio Ribeiro Gonçalves, Beatriz Borba E Silva, Izabely Dos Reis de Paula, Maria Antonia Oliveira Machado Pereira, Davi Santos Lima, Jacy Bezerra Parmera, Rubens Gisbert Cury, João Paulo Mota Telles

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引用次数: 0

Abstract

Introduction: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is a non-invasive treatment option for essential tremor (ET). Its use is often limited to patients with a skull density ratio (SDR) above 0.4, despite reports of positive outcomes in those with lower SDR.

Methods: A systematic review and meta-analysis were conducted according to Cochrane and PRISMA guidelines. We searched PubMed, Embase, and Cochrane Library for studies reporting clinical outcomes, sonication strategies, and adverse effects related to MRgFUS for ET according to SDR ratios. Low SDR was defined as ≤ 0.4, while high SDR was categorized as > 0.4. Data were analyzed using a random-effects model in RStudio 4.4.0, with standardized mean difference (SMD) and 95 % confidence interval (CI) used to compare tremor improvements.

Results: Five studies, including a total of 505 patients, were analyzed. Tremor reduction in patients with low SDR showed a pooled mean improvement of 48.81 % (95 % CI: 40.59 %-57.03 %) at three months post-treatment. Sustained tremor improvement was observed after 12 months, with a pooled mean of 45.58 % (95 % CI: 37.96 %-53.21 %). Comparison between low SDR and high SDR groups revealed no statistically significant difference in tremor improvement (SMD = -0.02; 95 % CI: -0.46 to 0.42; p = 0.93), indicating similar treatment responses.

Conclusions: These findings suggest that MRgFUS is an effective treatment for ET patients with low SDR, with sustainable tremor reduction up to one year post-treatment and comparable outcomes to those with higher SDR.

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磁共振引导聚焦超声治疗特发性震颤低颅密度患者：系统回顾和荟萃分析。

简介：磁共振引导聚焦超声（MRgFUS）丘脑切开术是特发性震颤（ET）的一种非侵入性治疗选择。它的使用通常仅限于颅骨密度比（SDR）高于0.4的患者，尽管有报道称较低SDR的患者预后良好。方法：根据Cochrane和PRISMA指南进行系统评价和荟萃分析。我们检索了PubMed、Embase和Cochrane图书馆，检索了根据SDR比例报告与MRgFUS治疗ET相关的临床结果、超声策略和不良反应的研究。低SDR定义为≤0.4，高SDR定义为> 0.4。使用RStudio 4.4.0中的随机效应模型对数据进行分析，使用标准化平均差（SMD）和95%置信区间（CI）来比较震颤的改善。结果：分析了5项研究，共505例患者。在治疗后3个月，低SDR患者的震颤减少显示了48.81% （95% CI: 40.59% - 57.03%）的综合平均改善。12个月后观察到持续震颤改善，合并平均值为45.58% （95% CI: 37.96% - 53.21%）。低SDR组与高SDR组比较，震颤改善无统计学差异(SMD = -0.02；95% CI: -0.46 ~ 0.42；P = 0.93)，表明治疗效果相似。结论：这些发现表明MRgFUS是低SDR ET患者的有效治疗方法，治疗后持续震颤减少长达一年，与高SDR患者的结果相当。

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

Parkinsonism & related disorders 医学-临床神经学

CiteScore

6.20

自引率

4.90%

发文量

292

审稿时长

39 days

期刊介绍： Parkinsonism & Related Disorders publishes the results of basic and clinical research contributing to the understanding, diagnosis and treatment of all neurodegenerative syndromes in which Parkinsonism, Essential Tremor or related movement disorders may be a feature. Regular features will include: Review Articles, Point of View articles, Full-length Articles, Short Communications, Case Reports and Letter to the Editor.