Neurosurgery · 2026
The Role of Biologically Effective Dose in Clinical Improvement and Hyper-Response After Gamma Knife Radiosurgery for Essential Tremor.
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Tuleasca Constantin, Sandu Silvia, Cretol Axelle, Witjas Tatiana, Régis Jean
Аннотация
BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) is a minimally invasive alternative for drug-resistant essential tremor (ET). The objective of this study was to evaluate whether biologically effective dose (BEDGy2.47) is relevant for tremor arrest after SRS for ET.
METHODS: Two hundred sixty-one cases were treated in Marseille University Hospital (CHU Timone) between January 2009 and June 2021. The median age was 71.9 years (39.9-91.5). The treated side was the left ventrointermediate nucleus in 237 cases (90.8%). 130 Gy was prescribed in all cases. The median BEDGy2.47 was 4119.3 (3649-4657.9).
RESULTS: The median clinical global impression alleviation was 80 (mean 69.6; 0-100). The median percentage of alleviation of the treated hand was 78.6% (mean 69.9; 7-100). A positive response after treatment was encountered in 213 patients (81.6%). The median magnetic resonance reaction volume was 0.085 cc (0-2.04). Radiological hyper-response was encountered in 28 cases (10.7%), with clinical hyper-response being transient and reversible and from which 4.2% was mild hemiparesis (as worse clinical hyper-response). Fractional polynomial revealed that probability of Clinical Global Impression improvement increased with BEDGy2.47, for values between 3600 and 4200, whereas tremor of the treated hand improvement was higher with BEDGy2.47 between 3800 and 4400 and positive response as a binary outcome suggested values of BEDGy2.47 more than 3800 and less than 4000 as relevant. Hyper-response probability was higher for BEDGy2.47 between 4000 and 4200.
CONCLUSION: BEDGy2.47 between 3800 and 4000 is considered as the optimal interval for better clinical improvement after SRS for drug-resistant ET, without magnetic resonance hyper-reaction and potential complications. Neuromodulation using this BED therapeutic window could potentially increase the efficacy and lower the toxicity of this procedure.
METHODS: Two hundred sixty-one cases were treated in Marseille University Hospital (CHU Timone) between January 2009 and June 2021. The median age was 71.9 years (39.9-91.5). The treated side was the left ventrointermediate nucleus in 237 cases (90.8%). 130 Gy was prescribed in all cases. The median BEDGy2.47 was 4119.3 (3649-4657.9).
RESULTS: The median clinical global impression alleviation was 80 (mean 69.6; 0-100). The median percentage of alleviation of the treated hand was 78.6% (mean 69.9; 7-100). A positive response after treatment was encountered in 213 patients (81.6%). The median magnetic resonance reaction volume was 0.085 cc (0-2.04). Radiological hyper-response was encountered in 28 cases (10.7%), with clinical hyper-response being transient and reversible and from which 4.2% was mild hemiparesis (as worse clinical hyper-response). Fractional polynomial revealed that probability of Clinical Global Impression improvement increased with BEDGy2.47, for values between 3600 and 4200, whereas tremor of the treated hand improvement was higher with BEDGy2.47 between 3800 and 4400 and positive response as a binary outcome suggested values of BEDGy2.47 more than 3800 and less than 4000 as relevant. Hyper-response probability was higher for BEDGy2.47 between 4000 and 4200.
CONCLUSION: BEDGy2.47 between 3800 and 4000 is considered as the optimal interval for better clinical improvement after SRS for drug-resistant ET, without magnetic resonance hyper-reaction and potential complications. Neuromodulation using this BED therapeutic window could potentially increase the efficacy and lower the toxicity of this procedure.