Parkinsonism & related disorders · 2025
Magnetic resonance-guided focused ultrasound for essential tremor patients with low skull density ratio: A systematic review and meta-analysis.
Систематический обзорСтатьяМетаанализНазвание и аннотация: Перевод в очереди
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Monteiro Júlia Dos Santos, de Oliveira Rafael Reis, Gonçalves Ocílio Ribeiro, Silva Beatriz Borba E, Paula Izabely Dos Reis de, Oliveira Machado Pereira Maria Antonia, Lima Davi Santos, Parmera Jacy Bezerra, Cury Rubens Gisbert, Mota Telles João Paulo
Аннотация
INTRODUCTION: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is a non-invasive treatment option for essential tremor (ET). Its use is often limited to patients with a skull density ratio (SDR) above 0.4, despite reports of positive outcomes in those with lower SDR.
METHODS: A systematic review and meta-analysis were conducted according to Cochrane and PRISMA guidelines. We searched PubMed, Embase, and Cochrane Library for studies reporting clinical outcomes, sonication strategies, and adverse effects related to MRgFUS for ET according to SDR ratios. Low SDR was defined as ≤ 0.4, while high SDR was categorized as > 0.4. Data were analyzed using a random-effects model in RStudio 4.4.0, with standardized mean difference (SMD) and 95 % confidence interval (CI) used to compare tremor improvements.
RESULTS: Five studies, including a total of 505 patients, were analyzed. Tremor reduction in patients with low SDR showed a pooled mean improvement of 48.81 % (95 % CI: 40.59 %-57.03 %) at three months post-treatment. Sustained tremor improvement was observed after 12 months, with a pooled mean of 45.58 % (95 % CI: 37.96 %-53.21 %). Comparison between low SDR and high SDR groups revealed no statistically significant difference in tremor improvement (SMD = -0.02; 95 % CI: -0.46 to 0.42; p = 0.93), indicating similar treatment responses.
CONCLUSIONS: These findings suggest that MRgFUS is an effective treatment for ET patients with low SDR, with sustainable tremor reduction up to one year post-treatment and comparable outcomes to those with higher SDR.
METHODS: A systematic review and meta-analysis were conducted according to Cochrane and PRISMA guidelines. We searched PubMed, Embase, and Cochrane Library for studies reporting clinical outcomes, sonication strategies, and adverse effects related to MRgFUS for ET according to SDR ratios. Low SDR was defined as ≤ 0.4, while high SDR was categorized as > 0.4. Data were analyzed using a random-effects model in RStudio 4.4.0, with standardized mean difference (SMD) and 95 % confidence interval (CI) used to compare tremor improvements.
RESULTS: Five studies, including a total of 505 patients, were analyzed. Tremor reduction in patients with low SDR showed a pooled mean improvement of 48.81 % (95 % CI: 40.59 %-57.03 %) at three months post-treatment. Sustained tremor improvement was observed after 12 months, with a pooled mean of 45.58 % (95 % CI: 37.96 %-53.21 %). Comparison between low SDR and high SDR groups revealed no statistically significant difference in tremor improvement (SMD = -0.02; 95 % CI: -0.46 to 0.42; p = 0.93), indicating similar treatment responses.
CONCLUSIONS: These findings suggest that MRgFUS is an effective treatment for ET patients with low SDR, with sustainable tremor reduction up to one year post-treatment and comparable outcomes to those with higher SDR.