Gamma Knife Thalamotomy for Disabling Tremor: A Blinded Evaluation
Identifieur interne : 001D11 ( Main/Exploration ); précédent : 001D10; suivant : 001D12Gamma Knife Thalamotomy for Disabling Tremor: A Blinded Evaluation
Auteurs : Shen-Yang Lim [Malaisie, Canada] ; Mojgan Hodaie [Canada] ; Melanie Fallis [Canada] ; Yu-Yan Poon [Canada] ; Filomena Mazzella [Canada] ; Elena Moro [Canada]Source :
- Archives of neurology : (Chicago) [ 0003-9942 ] ; 2010.
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- Pascal (Inist)
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Abstract
Background: Gamma knife thalamotomy (GKT) has been used as a therapeutic option for patients with disabling tremor refractory to medications. Impressive improvement of tremor has been reported in the neurosurgical literature, but the reliability of such data has been questioned. Objective: To prospectively evaluate clinical outcomes after GKT for disabling tremor with blinded assessments. Design: Prospective study with blinded independent neurologic evaluations. Setting: University hospital. Patients: Consecutive patients who underwent unilateral GKT for essential tremor and Parkinson disease tremor at our center. These patients were unwilling or deemed unsuitable candidates for deep brain stimulation or other surgical procedures. Interventions: Unilateral GKT and regular follow-up evaluations for up to 30 months, with blinded video evaluations by a movement disorders neurologist. Main Outcome Measures: Clinical outcomes, as measured by the Fahn-Tolosa-Marin Tremor Rating Scale and activities of daily living scores, and incidence of adverse events. Results: From September 1, 2006, to November 30, 2008, 18 patients underwent unilateral GKT for essential tremor and Parkinson disease tremor at our center. Videos for 14 patients (11 with essential tremor, 3 with Parkinson disease tremor) with at least 6 months' postoperative follow-up were available for analysis (mean [SD] follow-up duration, 19.2 [7.3] months; range, 7-30 months). The Fahn-Tolosa-Marin Tremor Rating Scale activities of daily living scores improved significantly after GKT (P=.03; median and mean change scores, 2.5 and 2.7 points, respectively [range of scale was 0-27]), but there was no significant improvement in other Fahn-Tolosa-Marin Tremor Rating Scale items (P=.53 for resting tremor, P=.24 for postural tremor, P=.62 for action tremor, P=.40 for drawing, P>.99 for pouring water, P=.89 for head tremor). Handwriting and Unified Parkinson's Disease Rating Scale activities of daily living scores tended to improve (P=.07 and .11, respectively). Three patients developed delayed neurologic adverse events. Conclusions: Overall, we found that GKT provided only modest antitremor efficacy. Of the 2 patients with essential tremor who experienced marked improvement in tremor, 1 subsequently experienced a serious adverse event. Further prospective studies with careful neurologic evaluation of outcomes are necessary before GKT can be recommended for disabling tremor on a routine clinical basis.
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Toronto</orgName></affiliation></author><author><name sortKey="Hodaie, Mojgan" sort="Hodaie, Mojgan" uniqKey="Hodaie M" first="Mojgan" last="Hodaie">Mojgan Hodaie</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Fallis, Melanie" sort="Fallis, Melanie" uniqKey="Fallis M" first="Melanie" last="Fallis">Melanie Fallis</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 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Mazzella</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region 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Evaluation</title><author><name sortKey="Lim, Shen Yang" sort="Lim, Shen Yang" uniqKey="Lim S" first="Shen-Yang" last="Lim">Shen-Yang Lim</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Faculty of Medicine, University of Malaya</s1><s2>Kuala Lumpur</s2><s3>MYS</s3><sZ>1 aut.</sZ></inist:fA14><country>Malaisie</country><wicri:noRegion>Kuala Lumpur</wicri:noRegion></affiliation><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Hodaie, Mojgan" sort="Hodaie, Mojgan" uniqKey="Hodaie M" first="Mojgan" last="Hodaie">Mojgan Hodaie</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Fallis, Melanie" sort="Fallis, Melanie" uniqKey="Fallis M" first="Melanie" last="Fallis">Melanie Fallis</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Poon, Yu Yan" sort="Poon, Yu Yan" uniqKey="Poon Y" first="Yu-Yan" last="Poon">Yu-Yan Poon</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Mazzella, Filomena" sort="Mazzella, Filomena" uniqKey="Mazzella F" first="Filomena" last="Mazzella">Filomena Mazzella</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Canada</country><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName><orgName type="university">Université de Toronto</orgName></affiliation></author></analytic><series><title level="j" type="main">Archives of neurology : (Chicago)</title><title level="j" type="abbreviated">Arch. neurol. : (Chic.)</title><idno type="ISSN">0003-9942</idno><imprint><date when="2010">2010</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Archives of neurology : (Chicago)</title><title level="j" type="abbreviated">Arch. neurol. : (Chic.)</title><idno type="ISSN">0003-9942</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Evaluation</term><term>Nervous system diseases</term><term>Thalamotomy</term><term>Tremor</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Tremblement</term><term>Pathologie du système nerveux</term><term>Thalamotomie</term><term>Evaluation</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: Gamma knife thalamotomy (GKT) has been used as a therapeutic option for patients with disabling tremor refractory to medications. Impressive improvement of tremor has been reported in the neurosurgical literature, but the reliability of such data has been questioned. Objective: To prospectively evaluate clinical outcomes after GKT for disabling tremor with blinded assessments. Design: Prospective study with blinded independent neurologic evaluations. Setting: University hospital. Patients: Consecutive patients who underwent unilateral GKT for essential tremor and Parkinson disease tremor at our center. These patients were unwilling or deemed unsuitable candidates for deep brain stimulation or other surgical procedures. Interventions: Unilateral GKT and regular follow-up evaluations for up to 30 months, with blinded video evaluations by a movement disorders neurologist. Main Outcome Measures: Clinical outcomes, as measured by the Fahn-Tolosa-Marin Tremor Rating Scale and activities of daily living scores, and incidence of adverse events. Results: From September 1, 2006, to November 30, 2008, 18 patients underwent unilateral GKT for essential tremor and Parkinson disease tremor at our center. Videos for 14 patients (11 with essential tremor, 3 with Parkinson disease tremor) with at least 6 months' postoperative follow-up were available for analysis (mean [SD] follow-up duration, 19.2 [7.3] months; range, 7-30 months). The Fahn-Tolosa-Marin Tremor Rating Scale activities of daily living scores improved significantly after GKT (P=.03; median and mean change scores, 2.5 and 2.7 points, respectively [range of scale was 0-27]), but there was no significant improvement in other Fahn-Tolosa-Marin Tremor Rating Scale items (P=.53 for resting tremor, P=.24 for postural tremor, P=.62 for action tremor, P=.40 for drawing, P>.99 for pouring water, P=.89 for head tremor). Handwriting and Unified Parkinson's Disease Rating Scale activities of daily living scores tended to improve (P=.07 and .11, respectively). Three patients developed delayed neurologic adverse events. Conclusions: Overall, we found that GKT provided only modest antitremor efficacy. Of the 2 patients with essential tremor who experienced marked improvement in tremor, 1 subsequently experienced a serious adverse event. Further prospective studies with careful neurologic evaluation of outcomes are necessary before GKT can be recommended for disabling tremor on a routine clinical basis.</div></front></TEI><affiliations><list><country><li>Canada</li><li>Malaisie</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Malaisie"><noRegion><name sortKey="Lim, Shen Yang" sort="Lim, Shen Yang" uniqKey="Lim S" first="Shen-Yang" last="Lim">Shen-Yang Lim</name></noRegion></country><country name="Canada"><region name="Ontario"><name sortKey="Lim, Shen Yang" sort="Lim, Shen Yang" uniqKey="Lim S" first="Shen-Yang" last="Lim">Shen-Yang Lim</name></region><name sortKey="Fallis, Melanie" sort="Fallis, Melanie" uniqKey="Fallis M" first="Melanie" last="Fallis">Melanie Fallis</name><name sortKey="Hodaie, Mojgan" sort="Hodaie, Mojgan" uniqKey="Hodaie M" first="Mojgan" last="Hodaie">Mojgan Hodaie</name><name sortKey="Mazzella, Filomena" sort="Mazzella, Filomena" uniqKey="Mazzella F" first="Filomena" last="Mazzella">Filomena Mazzella</name><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><name sortKey="Poon, Yu Yan" sort="Poon, Yu Yan" uniqKey="Poon Y" first="Yu-Yan" last="Poon">Yu-Yan Poon</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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