Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Radiosurgery Safe, Valuable for Essential Tremor
Mov Disord; ePub 2017 Mar 20; Niranjan, et al
Radiosurgery is a safe and valuable treatment option for medically refractory essential tremor, especially for the elderly or those with high surgical risk for deep brain stimulation (DBS) or radiofrequency thalamotomy, a recent study found. During a 19-year period (1996–2015), researchers evaluated 73 patients who underwent gamma knife thalamotomy for intractable essential tremor. A median central dose of 140 Gy (range, 130–150) was delivered to the nucleus ventralis intermedius through a single 4-mm isocenter. Researchers used the Fahn-Tolosa-Marin clinical tremor rating scale to score tremor, handwriting, drawing, and ability to drink fluids. The median time to last follow-up was 28 months. They found:
- After gamma knife thalamotomy, 93.2% improved in tremor.
- 44 patients (60.3%) experienced tremor arrest or barely perceptible tremor.
- 18 patients (24.7%) noted tremor arrest and complete restoration of motor function.
- Tremor improvement was sustained at last follow-up in 96% of patients who experienced tremor relief.
- Mean tremor score improved from 3.19 before to 1.27 after gamma knife thalamotomy.
Niranjan A, Raju SS, Kooshkabadi A, Monaco III E, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for essential tremor: Retrospective analysis of a 19-year experience. [Published online ahead of print March 20, 2017]. Mov Disord. doi:10.1002/mds.26925.