A preliminary study on the mechanism of ipsilateral tremor relief in essential tremor patients treated with unilateral MR-guided focused ultrasound thalamotomy
Objective To investigate the effect of unilateral MR-guided focused ultrasound(MRgFUS)thalamotomy on ipsilateral hand tremor in patients with essential tremor(ET)and its possible mechanism.Methods A retrospective analysis was conducted on clinical data of ET patients who received unilateral MRgFUS thalamotomy at the Department of Neurosurgery,First Medical Center of PLA General Hospital from January 2019 to June 2022.The linear mixed-effect model(LMM)was used for the analysis of tremor scores and non-decussating dentato-rubro-thalamic tract(nd-DRTT)at 1,3,6 and 12 months after surgery,as compared to those before surgery.The mediation effect of nd-DRTT in the alteration of ipsilateral tremor scores was also explored.Results Ipsilateral tremor scores of 50 ET patients decreased from 16.1±5.5 to 12.6±6.0,12.5±6.5,12.6±6.1 and 12.8±6.9 at 1,3,6 and 12 months post operation respectively(all P＜0.001).Contralateral tremor scores decreased from 21.5±4.0 to 4.1±3.8,4.9± 4.5,6.2±5.5 and 6.9±5.7 at 1,3,6 and 12 months post operation respectively(all P＜0.001).Compared with preoperative level(150.4±89.9),there was a significant decrease in the number of ipsilateral nd-DRTT both at 1 month(38.9±38.0)and 3 months(69.2±61.7)after thalamotomy(both P＜0.05),while no statistically significant decrease was observed at 6 and 12 months(both P＞0.05).Compared with preoperative level(132.6±75.6),the number of contralateral nd-DRTT after thalamotomy at different time points showed a decreasing trend,but did not reach statistical significance(all P＞0.05).The decrease of nd-DRTT after thalamotomy(β=-18.64,P=0.001)had a mediation effect(β=0.01,P=0.007)in the decrease of ipsilateral tremor score(β=-4.39,P＜0.001).Conclusion Preliminary results show that unilateral MRgFUS thalamotomy could partially mediate the relief of ipsilateral tremor via reducing ipsilateral nd-DRTT.
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