Patient satisfaction following unilateral MR-guided focused ultrasound for tremor: Who is satisfied and who is not?

Cognitive Outcomes Following Second-Sided Focused Ultrasound Thalamotomy for Tremor

BACKGROUND

Historically, staged bilateral thalamotomy has been associated with cognitive decline.

OBJECTIVE

To examine cognitive outcomes of second-sided focused ultrasound (FUS) thalamotomy in individuals with medication-refractory essential tremor (ET) who previously underwent unilateral FUS thalamotomy.

METHODS

Twenty-one individuals with medication-refractory ET completed cognitive testing before undergoing second-sided FUS thalamotomy and 4 months post-FUS. Cognitive changes were analyzed at the group and individual levels.

RESULTS

At the group level, no significant declines were observed on any of the test scores. At the individual level, most cognitive test scores remained stable (95% of scores), with declines (2% of scores) and improvements (3% of scores) occurring infrequently. Specifically, declines were observed on only four of the 19 cognitive test scores. No more than two participants declined on any single test score and no participant declined on more than two cognitive test scores.

CONCLUSIONS

Second-sided FUS thalamotomy is associated with minimal risk of cognitive decline.

Intraprocedural Three-Dimensional Imaging Registration Optimizes Magnetic Resonance Imaging-Guided Focused Ultrasound and Facilitates Novel Applications

BACKGROUND AND OBJECTIVE

Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) has revolutionized ablative treatment of essential tremor in recent years. However, limitations in precision targeting may account for suboptimal efficacy and significant side effects. We describe a simple intraprocedural three-dimensional image-guided lesion shaping technique that can improve overall outcomes of MRgFUS for essential tremor and facilitate expansion to novel indications.

METHODS

A retrospective review of 84 consecutive MRgFUS procedures performed at Pennsylvania Hospital was performed. Comparison of patient demographics, treatment parameters, and clinical outcomes before and after implementation of this protocol was conducted. Further application of this technique in pallidotomy treatments and ablative disconnection of hypothalamic hamartoma are described.

RESULTS

After implementation, the median of total number of sonications (7 vs 9, P = .001), number of therapeutic sonications (3 vs 4, P < .0001), and interval time between the first and last sonication (46:10 vs 68:53 minutes, P = .0004) were significantly reduced. Patients expressed greater satisfaction of treatment (94.1% vs 82.4%, P = .018), greater global impression of change (CGI) (7 vs 6, P = .033), and reduced median number of side effects at 6 months (0 vs 1, P = .026). We also successfully implemented this protocol for novel indications.

CONCLUSION

Intraprocedural lesion shaping for MRgFUS is a simple and versatile imaging protocol augmentation that improves ablation precision and can improve treatment efficacy and broader neurological application.

Patient-reported treatment satisfaction in essential tremor: levels of satisfaction and predictors of satisfaction

Background

Although managing symptoms is paramount for both essential tremor (ET) patients and their healthcare providers, studies of treatment satisfaction are surprisingly lacking.

Objectives

We evaluated the satisfaction of patients who used a range of treatments and assessed the relation of a wide array of factors to satisfaction.

Methods

One hundred four ET participants (age = 74.5 ± 10.2 years) completed a battery of self-report items. These included demographic information, measures of tremor and clinical history, psychological state, current ET treatment, and a series of questions about satisfaction with treatment.

Results

Analyses of responses to the four current treatment satisfaction questions revealed that the proportion of participants who were satisfied ranged from 35.0% to 57.3% (i.e., approximately 1/3 to 1/2); conversely, the proportion who were dissatisfied ranged from 9.2% to 37.0%. The remainder were neutral. Higher satisfaction levels were observed in participants who were included in treatment selection and who had undergone deep brain stimulation surgery, p's < 0.05. Lower levels of satisfaction were found in participants with a negative psychological state, higher self-rated tremor severity, head/voice/jaw tremors, and more severe physical side effects; and who used botulinum toxin therapy, p's < 0.05.

Conclusion

Between 1/3 and 1/2 of patients were satisfied with their treatment, whereas up to 1/3 were dissatisfied. In this initial exploration of correlates of treatment satisfaction in ET patients, we identified a number of associations between satisfaction and clinical, psychological and treatment variables. Additional research is warranted to further explore the nature of these relations over time.