Journal Article

Unilateral gamma knife thalamotomy for tremor safety and efficacy in multimodal assessment: a prospective case-control study with two-year follow-up

Dzierzęcki, Sebastian, Szlufik, Stanisław, Kowalska-Taczanowska, Renata, Ząbek, Mirosław, Drzewińska, Agnieszka, Friedman, Andrzej, Szumilas, Mateusz, Bochniak, Katarzyna, Przytycka, Joanna, Ziobro, Anna, Sadowski, Karol, Figura, Monika, Korn, Aleksandra, Koziorowski, Dariusz, Duszyńska-Wąs, Karolina, Milanowski, Łukasz, Kłoda, Maria

2024

Overview

Unilateral gamma knife thalamotomy (GKT) is a treatment option for pharmacoresistant tremor of various aetiologies. There have been to date no randomised controlled trials performed to assess its safety and efficacy. Our aim was to summarise a two-year multimodal observation of patients with tremor caused by Parkinson's Disease (PD) or essential tremor (ET). 23 patients with PD (n = 12) or ET (n = 11) were included. They underwent assessments before, V0 (n = 23), and 12 months, V12 (n = 23), and 24 months, V24 (n = 15), after unilateral GKT. Patients were assessed with psychological tests and acoustic voice analysis. Tremor assessment was performed with a digitising table using the Fahn-Tolosa-Marin rating scale (FTMRS). The Unified Parkinson's Disease rating scale part III (UPDRS-III) was also used in the PD group. Gait and balance was assessed using clinical tests, stabilometric platform, and treadmill. No side effects were observed in a two-year follow-up. There was no notable deterioration observed in the patients' psychological evaluation, speech, or assessment of gait and balance. The scores were significantly lower (p = 0.01) in parts A and B of FTMRS one year after GKT. In post hoc analysis, the scores did not differ significantly between V0 and V24. In FTMRS part C (activities of daily living), no significant change was observed. There was no significant difference in total UPDRS part III score or in score of UPDRS part III domains 3 and 4 ('tremor at rest' and 'action and postural tremor of hands') between measurements. UGKT may be a safe treatment modality if performed in an experienced centre. Tremor reduction may diminish over time, and UGKT did not lead to cognitive, gait or speech deterioration in a long-term observation.

• Publisher: Wydawnictwo Via Medica
• Subject: Aged / Case-Control Studies / Essential Tremor - surgery / Female / Follow-Up Studies / Gait / Humans / Male / Middle Aged / Parkinson Disease - complications / Parkinson Disease - surgery / Prospective Studies / Radiosurgery - methods / Thalamus - surgery / Treatment Outcome / Tremor (Muscular contraction) / Tremor - surgery