Talamotomía unilateral con ultrasonidos focales de alta intensidad en el temblor refractario. Primeros resultados de un hospital público en España

IF 3.1 4区医学 Q2 CLINICAL NEUROLOGY

Neurologia Pub Date : 2025-10-01 DOI:10.1016/j.nrl.2023.02.012

G. Fernández-Pajarín , M. Blanco-Ulla , E. Arán , B. Ares , P. Román-Pena , A. Jesús Mosqueira , I. Jiménez-Martín , M. Gelabert-González , J.M. Prieto-González , Á. Sesar

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Abstract

Introduction

Unilateral high-intensity focused ultrasound (HIFU) thalamotomy is a novel and efficient treatment for refractory tremor. In the most recent studies, the tremor is reduced by at least 70%. The objective of this study is to analyse the results of the first series of cases treated in a public hospital in Spain.

Methods

In our centre, from March 2021 to March 2022, 46 patients have undergone a HIFU thalamotomy. The treatment area was predetermined on the inferior surface of the ventral intermediate nucleus of the thalamus using automatic anatomical segmentation on an individual basis. The data of 44 patients 6 months after the procedure have been analysed.

Results

The mean age of the treated patients was 70.5 ± 14.4 years, and 68% were male. The most common diagnosis was essential tremor (40 cases). Prior to HIFU treatment, the Clinical Rating Scale for Tremor of the treated body side (CRST A + B) was 22.4 ± 5.9, and tremor-related disability (CRST C) was 18.3 ± 4.8. The mean number of sonications was 6.8 ± 1.7. Six months after treatment, CRST scales were 4.5 ± 5.6 and 4.2 ± 5.2, respectively (P<.0001). Twenty patients had head tremor. We observed a significant improvement with HIFU (1.9 ± 0.7 to 0.7 ± 0.8, P<.0001). Only 4 patients presented adverse effects at 6 months, all of them mild.

Conclusions

The clinical benefit after HIFU thalamotomy reaches an 80% reduction in tremor and has a low rate of adverse effects 6 months after the procedure. The target localisation method used allowed for fewer sonications.

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在震颤中使用高强度聚焦超声的单侧腹腔镜切开术。西班牙公立医院的第一个结果

单侧高强度聚焦超声（HIFU）丘脑切开术是治疗顽固性震颤的一种新颖有效的方法。在最近的研究中，震颤至少减少了70%。本研究的目的是分析在西班牙一家公立医院治疗的第一批病例的结果。方法本中心于2021年3月至2022年3月共收治46例患者行HIFU丘脑切开术。治疗区域在丘脑腹侧中间核的下表面上预先确定，使用自动解剖分割的个体基础上。对44例患者术后6个月的资料进行了分析。结果患者平均年龄70.5±14.4岁，男性占68%。最常见的诊断是特发性震颤（40例）。HIFU治疗前，治疗体侧震颤临床评分（CRST A + B）为22.4±5.9，震颤相关残疾（CRST C）为18.3±4.8。平均超声检查次数为6.8±1.7次。治疗6个月后，CRST评分分别为4.5±5.6和4.2±5.2 （P<.0001）。20例患者有头部震颤。我们观察到HIFU的显著改善（1.9±0.7至0.7±0.8,P< 0.0001）。6个月时仅有4例出现不良反应，均为轻度。结论HIFU丘脑切开术术后6个月震颤减少80%，不良反应发生率低。使用的目标定位方法允许较少的超声波。

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

Neurologia 医学-临床神经学

CiteScore

5.90

自引率

2.60%

发文量

135

审稿时长

48 days

期刊介绍： Neurología es la revista oficial de la Sociedad Española de Neurología y publica, desde 1986 contribuciones científicas en el campo de la neurología clínica y experimental. Los contenidos de Neurología abarcan desde la neuroepidemiología, la clínica neurológica, la gestión y asistencia neurológica y la terapéutica, a la investigación básica en neurociencias aplicada a la neurología. Las áreas temáticas de la revistas incluyen la neurologia infantil, la neuropsicología, la neurorehabilitación y la neurogeriatría. Los artículos publicados en Neurología siguen un proceso de revisión por doble ciego a fin de que los trabajos sean seleccionados atendiendo a su calidad, originalidad e interés y así estén sometidos a un proceso de mejora. El formato de artículos incluye Editoriales, Originales, Revisiones y Cartas al Editor, Neurología es el vehículo de información científica de reconocida calidad en profesionales interesados en la neurología que utilizan el español, como demuestra su inclusión en los más prestigiosos y selectivos índices bibliográficos del mundo.