Gamma Knife Thalamotomy for Disabling Tremor: A Blinded Evaluation
Identifieur interne : 000436 ( PascalFrancis/Corpus ); précédent : 000435; suivant : 000437Gamma Knife Thalamotomy for Disabling Tremor: A Blinded Evaluation
Auteurs : Shen-Yang Lim ; Mojgan Hodaie ; Melanie Fallis ; Yu-Yan Poon ; Filomena Mazzella ; Elena MoroSource :
- Archives of neurology : (Chicago) [ 0003-9942 ] ; 2010.
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- Pascal (Inist)
English descriptors
- KwdEn :
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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| pA |
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|---|
Format Inist (serveur)
| NO : | PASCAL 10-0257885 INIST |
|---|---|
| ET : | Gamma Knife Thalamotomy for Disabling Tremor: A Blinded Evaluation |
| AU : | LIM (Shen-Yang); HODAIE (Mojgan); FALLIS (Melanie); POON (Yu-Yan); MAZZELLA (Filomena); MORO (Elena) |
| AF : | Faculty of Medicine, University of Malaya/Kuala Lumpur/Malaisie (1 aut.); Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto/Toronto, Ontario/Canada (1 aut., 3 aut., 4 aut., 5 aut., 6 aut.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto/Toronto, Ontario/Canada (2 aut.) |
| DT : | Publication en série; Niveau analytique |
| SO : | Archives of neurology : (Chicago); ISSN 0003-9942; Coden ARNEAS; Etats-Unis; Da. 2010; Vol. 67; No. 5; Pp. 584-588; Bibl. 15 ref. |
| LA : | Anglais |
| EA : | 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. |
| CC : | 002B17; 002B17A01 |
| FD : | Tremblement; Pathologie du système nerveux; Thalamotomie; Evaluation |
| FG : | Mouvement involontaire; Trouble neurologique |
| ED : | Tremor; Nervous system diseases; Thalamotomy; Evaluation |
| EG : | Involuntary movement; Neurological disorder |
| SD : | Temblor; Sistema nervioso patología; Talamotomía; Evaluación |
| LO : | INIST-2048B.354000181757200090 |
| ID : | 10-0257885 |
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Toronto</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>2 aut.</sZ></inist:fA14></affiliation></author><author><name sortKey="Fallis, Melanie" sort="Fallis, Melanie" uniqKey="Fallis M" first="Melanie" last="Fallis">Melanie Fallis</name><affiliation><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></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><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></affiliation></author><author><name sortKey="Mazzella, Filomena" sort="Mazzella, Filomena" uniqKey="Mazzella F" first="Filomena" last="Mazzella">Filomena Mazzella</name><affiliation><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></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><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></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">10-0257885</idno><date when="2010">2010</date><idno type="stanalyst">PASCAL 10-0257885 INIST</idno><idno type="RBID">Pascal:10-0257885</idno><idno type="wicri:Area/PascalFrancis/Corpus">000436</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Gamma Knife Thalamotomy for Disabling Tremor: A Blinded 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><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></affiliation><affiliation><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></affiliation></author><author><name sortKey="Hodaie, Mojgan" sort="Hodaie, Mojgan" uniqKey="Hodaie M" first="Mojgan" last="Hodaie">Mojgan Hodaie</name><affiliation><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></affiliation></author><author><name sortKey="Fallis, Melanie" sort="Fallis, Melanie" uniqKey="Fallis M" first="Melanie" last="Fallis">Melanie Fallis</name><affiliation><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></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><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></affiliation></author><author><name sortKey="Mazzella, Filomena" sort="Mazzella, Filomena" uniqKey="Mazzella F" first="Filomena" last="Mazzella">Filomena Mazzella</name><affiliation><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></affiliation></author><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation><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></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><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0003-9942</s0></fA01><fA02 i1="01"><s0>ARNEAS</s0></fA02><fA03 i2="1"><s0>Arch. neurol. : (Chic.)</s0></fA03><fA05><s2>67</s2></fA05><fA06><s2>5</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Gamma Knife Thalamotomy for Disabling Tremor: A Blinded Evaluation</s1></fA08><fA11 i1="01" i2="1"><s1>LIM (Shen-Yang)</s1></fA11><fA11 i1="02" i2="1"><s1>HODAIE (Mojgan)</s1></fA11><fA11 i1="03" i2="1"><s1>FALLIS (Melanie)</s1></fA11><fA11 i1="04" i2="1"><s1>POON (Yu-Yan)</s1></fA11><fA11 i1="05" i2="1"><s1>MAZZELLA (Filomena)</s1></fA11><fA11 i1="06" i2="1"><s1>MORO (Elena)</s1></fA11><fA14 i1="01"><s1>Faculty of Medicine, University of Malaya</s1><s2>Kuala Lumpur</s2><s3>MYS</s3><sZ>1 aut.</sZ></fA14><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></fA14><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></fA14><fA20><s1>584-588</s1></fA20><fA21><s1>2010</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>2048B</s2><s5>354000181757200090</s5></fA43><fA44><s0>0000</s0><s1>© 2010 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>15 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>10-0257885</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Archives of neurology : (Chicago)</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>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.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17</s0></fC02><fC02 i1="02" i2="X"><s0>002B17A01</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Tremblement</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Tremor</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Temblor</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Thalamotomie</s0><s5>09</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Thalamotomy</s0><s5>09</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Talamotomía</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Evaluation</s0><s5>10</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Evaluation</s0><s5>10</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Evaluación</s0><s5>10</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Mouvement involontaire</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Involuntary movement</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Movimiento involuntario</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Trouble neurologique</s0><s5>39</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Neurological disorder</s0><s5>39</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Trastorno neurológico</s0><s5>39</s5></fC07><fN21><s1>172</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard><server><NO>PASCAL 10-0257885 INIST</NO><ET>Gamma Knife Thalamotomy for Disabling Tremor: A Blinded Evaluation</ET><AU>LIM (Shen-Yang); HODAIE (Mojgan); FALLIS (Melanie); POON (Yu-Yan); MAZZELLA (Filomena); MORO (Elena)</AU><AF>Faculty of Medicine, University of Malaya/Kuala Lumpur/Malaisie (1 aut.); Movement Disorders Centre, Toronto Western Hospital, University Health Network, University of Toronto/Toronto, Ontario/Canada (1 aut., 3 aut., 4 aut., 5 aut., 6 aut.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto/Toronto, Ontario/Canada (2 aut.)</AF><DT>Publication en série; Niveau analytique</DT><SO>Archives of neurology : (Chicago); ISSN 0003-9942; Coden ARNEAS; Etats-Unis; Da. 2010; Vol. 67; No. 5; Pp. 584-588; Bibl. 15 ref.</SO><LA>Anglais</LA><EA>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.</EA><CC>002B17; 002B17A01</CC><FD>Tremblement; Pathologie du système nerveux; Thalamotomie; Evaluation</FD><FG>Mouvement involontaire; Trouble neurologique</FG><ED>Tremor; Nervous system diseases; Thalamotomy; Evaluation</ED><EG>Involuntary movement; Neurological disorder</EG><SD>Temblor; Sistema nervioso patología; Talamotomía; Evaluación</SD><LO>INIST-2048B.354000181757200090</LO><ID>10-0257885</ID></server></inist></record>Pour manipuler ce document sous Unix (Dilib)
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|type= RBID
|clé= Pascal:10-0257885
|texte= Gamma Knife Thalamotomy for Disabling Tremor: A Blinded Evaluation
}}
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