Is Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound a Repeatable Treatment Option? Case Report of a Retreated Patient With Tremor Combined With Parkinsonism

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Abstract

INTRODUCTION:In recent years, transcranial Magnetic Resonance Imaging-guidedFocused Ultrasound (tcMRgFUS) treatments for functional neurological disorders aregiving a new thrust to the field of therapeutic brain lesioning.OBJECTIVE:To present the case of a patient affected by tremor combined with Parkin-sonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremorafter a few months from the first tcMRgFUS treatment.METHODS:A 72-yr-old, right-handed man, came to our observation because of a disablingtremor affecting his upper limbs, refusing any invasive surgical procedure and alreadytreated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration,as a progressive recurrence of tremor on the right upper limb was observed after a fewmonths from the first treatment. Thus, the patient underwent a new left-sided tcMRgFUSprocedure 6 mo after the former treatment.RESULTS:After the second procedure, an immediate and complete relief from tremoron the right upper limb was achieved with clinical benefit that persisted up to a 6-mofollow-up.CONCLUSION:Since tcMRgFUS doesn’t use ionizing radiations and it is incision-less,repeated and staged treatment procedures have always been hypothesized. Our reportsuggests that tcMRgFUS retreatment might actually be a feasible, safe, and effective optionin selected patients in whom an optimal clinical outcome is not achieved after the firsttreatment session. However, future well-designed studies in large samples are needed toassess the possible risks of retreatment and the optimal timing of reintervention as well aseligibility and exclusion criteria.
Original languageEnglish
Number of pages6
JournalOperative Neurosurgery
Publication statusPublished - 2019

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Parkinsonian Disorders
Tremor
Magnetic Resonance Imaging
Upper Extremity
Retreatment
Therapeutics
Ionizing Radiation
Nervous System Diseases
Observation
Recurrence
Brain

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@article{ef56d630bc6d4244869fe03d78acaa99,
title = "Is Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound a Repeatable Treatment Option? Case Report of a Retreated Patient With Tremor Combined With Parkinsonism",
abstract = "INTRODUCTION:In recent years, transcranial Magnetic Resonance Imaging-guidedFocused Ultrasound (tcMRgFUS) treatments for functional neurological disorders aregiving a new thrust to the field of therapeutic brain lesioning.OBJECTIVE:To present the case of a patient affected by tremor combined with Parkin-sonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremorafter a few months from the first tcMRgFUS treatment.METHODS:A 72-yr-old, right-handed man, came to our observation because of a disablingtremor affecting his upper limbs, refusing any invasive surgical procedure and alreadytreated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration,as a progressive recurrence of tremor on the right upper limb was observed after a fewmonths from the first treatment. Thus, the patient underwent a new left-sided tcMRgFUSprocedure 6 mo after the former treatment.RESULTS:After the second procedure, an immediate and complete relief from tremoron the right upper limb was achieved with clinical benefit that persisted up to a 6-mofollow-up.CONCLUSION:Since tcMRgFUS doesn’t use ionizing radiations and it is incision-less,repeated and staged treatment procedures have always been hypothesized. Our reportsuggests that tcMRgFUS retreatment might actually be a feasible, safe, and effective optionin selected patients in whom an optimal clinical outcome is not achieved after the firsttreatment session. However, future well-designed studies in large samples are needed toassess the possible risks of retreatment and the optimal timing of reintervention as well aseligibility and exclusion criteria.",
author = "Cesare Gagliardo and Maurizio Marrale and Domenico Iacopino and Bartolotta, {Tommaso Vincenzo} and Giuseppe Cosentino and Francesca Valentino and Giammalva, {Giuseppe Roberto}",
year = "2019",
language = "English",
journal = "Operative Neurosurgery",
issn = "2332-4252",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Is Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound a Repeatable Treatment Option? Case Report of a Retreated Patient With Tremor Combined With Parkinsonism

AU - Gagliardo, Cesare

AU - Marrale, Maurizio

AU - Iacopino, Domenico

AU - Bartolotta, Tommaso Vincenzo

AU - Cosentino, Giuseppe

AU - Valentino, Francesca

AU - Giammalva, Giuseppe Roberto

PY - 2019

Y1 - 2019

N2 - INTRODUCTION:In recent years, transcranial Magnetic Resonance Imaging-guidedFocused Ultrasound (tcMRgFUS) treatments for functional neurological disorders aregiving a new thrust to the field of therapeutic brain lesioning.OBJECTIVE:To present the case of a patient affected by tremor combined with Parkin-sonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremorafter a few months from the first tcMRgFUS treatment.METHODS:A 72-yr-old, right-handed man, came to our observation because of a disablingtremor affecting his upper limbs, refusing any invasive surgical procedure and alreadytreated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration,as a progressive recurrence of tremor on the right upper limb was observed after a fewmonths from the first treatment. Thus, the patient underwent a new left-sided tcMRgFUSprocedure 6 mo after the former treatment.RESULTS:After the second procedure, an immediate and complete relief from tremoron the right upper limb was achieved with clinical benefit that persisted up to a 6-mofollow-up.CONCLUSION:Since tcMRgFUS doesn’t use ionizing radiations and it is incision-less,repeated and staged treatment procedures have always been hypothesized. Our reportsuggests that tcMRgFUS retreatment might actually be a feasible, safe, and effective optionin selected patients in whom an optimal clinical outcome is not achieved after the firsttreatment session. However, future well-designed studies in large samples are needed toassess the possible risks of retreatment and the optimal timing of reintervention as well aseligibility and exclusion criteria.

AB - INTRODUCTION:In recent years, transcranial Magnetic Resonance Imaging-guidedFocused Ultrasound (tcMRgFUS) treatments for functional neurological disorders aregiving a new thrust to the field of therapeutic brain lesioning.OBJECTIVE:To present the case of a patient affected by tremor combined with Parkin-sonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremorafter a few months from the first tcMRgFUS treatment.METHODS:A 72-yr-old, right-handed man, came to our observation because of a disablingtremor affecting his upper limbs, refusing any invasive surgical procedure and alreadytreated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration,as a progressive recurrence of tremor on the right upper limb was observed after a fewmonths from the first treatment. Thus, the patient underwent a new left-sided tcMRgFUSprocedure 6 mo after the former treatment.RESULTS:After the second procedure, an immediate and complete relief from tremoron the right upper limb was achieved with clinical benefit that persisted up to a 6-mofollow-up.CONCLUSION:Since tcMRgFUS doesn’t use ionizing radiations and it is incision-less,repeated and staged treatment procedures have always been hypothesized. Our reportsuggests that tcMRgFUS retreatment might actually be a feasible, safe, and effective optionin selected patients in whom an optimal clinical outcome is not achieved after the firsttreatment session. However, future well-designed studies in large samples are needed toassess the possible risks of retreatment and the optimal timing of reintervention as well aseligibility and exclusion criteria.

UR - http://hdl.handle.net/10447/374157

UR - https://academic.oup.com/ons/advance-article/doi/10.1093/ons/opz300/5584507

M3 - Article

JO - Operative Neurosurgery

JF - Operative Neurosurgery

SN - 2332-4252

ER -