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Noninvasive Thalamotomy for Refractory Tremor by Frameless Radiosurgery.

Publication ,  Journal Article
Khattab, MH; Cmelak, AJ; Sherry, AD; Luo, G; Wang, L; Yu, H; Hedera, P; Phibbs, FT; Lindsell, CJ; Neimat, J; Kirschner, AN
Published in: Int J Radiat Oncol Biol Phys
January 1, 2022

PURPOSE: We sought to determine whether a more widely accessible, noninvasive, frameless approach to radiosurgical thalamotomy would improve objective measures of refractory essential or parkinsonian tremor without added toxicity compared with reports of frame-based radiosurgery. METHODS AND MATERIALS: We conducted a single-arm pilot observational prospective trial of adult patients with essential or parkinsonian tremor from 2013 to 2019 and report results at 1-year follow-up. Patients were treated with frameless unilateral radiosurgical ablation of the thalamic ventral intermediate nucleus to a maximum dose of 160 Gy. Treatment response was measured by the Fahn-Tolosa-Marin (FTM) tremor rating scale and the Quality of Life in Essential Tremor or Parkinson's Disease Questionnaire obtained before treatment and at 3, 6, 9, and 12 months. RESULTS: Thirty-three patients, including 23 with essential tremor and 10 with Parkinson's disease, were enrolled. Overall treatment response rate per FTM was 83% (15 of 18) at 6 months. There was a marked improvement in tremor, with an average total FTM reduction of 21% at 3 months (from 46 to 30 points; P = .003) and 41% at 6 months (from 46 to 24 points; P = .001). At 6 months, functional decline had regressed by 54% (from 15 to 7 points; P = .001). Quality of life improved by 57% (P = .001) at 6 months in patients with essential tremor, and patients with Parkinson's disease had unchanged quality of life. At 1-year follow-up, grade 2 neurologic adverse events were observed in 6% (2 of 33) of patients without any grade ≥ 3 events. CONCLUSION: Noninvasive, frameless radiosurgical thalamotomy may be a feasible treatment for patients with refractory tremor and demonstrates short-term safety at 1-year follow-up. This pilot study provides promising preliminary descriptions of efficacy, and definitive estimates of long-term safety and benefit require further study with longer follow-up.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

January 1, 2022

Volume

112

Issue

1

Start / End Page

121 / 130

Location

United States

Related Subject Headings

  • Tremor
  • Treatment Outcome
  • Thalamus
  • Radiosurgery
  • Quality of Life
  • Prospective Studies
  • Pilot Projects
  • Oncology & Carcinogenesis
  • Humans
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Khattab, M. H., Cmelak, A. J., Sherry, A. D., Luo, G., Wang, L., Yu, H., … Kirschner, A. N. (2022). Noninvasive Thalamotomy for Refractory Tremor by Frameless Radiosurgery. Int J Radiat Oncol Biol Phys, 112(1), 121–130. https://doi.org/10.1016/j.ijrobp.2021.08.021
Khattab, Mohamed H., Anthony J. Cmelak, Alexander D. Sherry, Guozhen Luo, Li Wang, Hong Yu, Peter Hedera, et al. “Noninvasive Thalamotomy for Refractory Tremor by Frameless Radiosurgery.Int J Radiat Oncol Biol Phys 112, no. 1 (January 1, 2022): 121–30. https://doi.org/10.1016/j.ijrobp.2021.08.021.
Khattab MH, Cmelak AJ, Sherry AD, Luo G, Wang L, Yu H, et al. Noninvasive Thalamotomy for Refractory Tremor by Frameless Radiosurgery. Int J Radiat Oncol Biol Phys. 2022 Jan 1;112(1):121–30.
Khattab, Mohamed H., et al. “Noninvasive Thalamotomy for Refractory Tremor by Frameless Radiosurgery.Int J Radiat Oncol Biol Phys, vol. 112, no. 1, Jan. 2022, pp. 121–30. Pubmed, doi:10.1016/j.ijrobp.2021.08.021.
Khattab MH, Cmelak AJ, Sherry AD, Luo G, Wang L, Yu H, Hedera P, Phibbs FT, Lindsell CJ, Neimat J, Kirschner AN. Noninvasive Thalamotomy for Refractory Tremor by Frameless Radiosurgery. Int J Radiat Oncol Biol Phys. 2022 Jan 1;112(1):121–130.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

January 1, 2022

Volume

112

Issue

1

Start / End Page

121 / 130

Location

United States

Related Subject Headings

  • Tremor
  • Treatment Outcome
  • Thalamus
  • Radiosurgery
  • Quality of Life
  • Prospective Studies
  • Pilot Projects
  • Oncology & Carcinogenesis
  • Humans
  • Adult