Transcranial magnetic resonance-guided focused ultrasound thalamotomy as a safe treatment option in multiple sclerosis p
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Transcranial magnetic resonance-guided focused ultrasound thalamotomy as a safe treatment option in multiple sclerosis patients with essential tremor Cesare Gagliardo 1 Marco D’Amelio 2
&
Paolo Ragonese 2 & Gerardo Domenico Iacopino 3 & Giuseppe Salemi 2 & Massimo Midiri 1 &
Received: 15 June 2020 / Accepted: 16 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Transcranial magnetic resonance-guided focused ultrasound is a recently introduced incisionless treating option for essential tremor and tremor-dominant idiopathic Parkinson disease. There is preliminary evidence that it may result in a promising effective treatment option for other movement disorders too. Here, we report on two patients with multiple sclerosis with medication refractory debilitating essential tremor comorbidity who successfully underwent unilateral Vim tcMRgFUS thalamotomy for tremor control. Patients’ clinical condition and expanded disability status scale scores showed no changes during the 1-year follow-up period with no evidence of multiple sclerosis activity or progression. Keywords Multiple Sclerosis . Essential Tremor . High-Intensity Focused Ultrasound Ablation . Interventional Magnetic Resonance Imaging . Stereotaxic Techniques
Introduction Transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) has emerged as an incisionless, safe [1, 2], accurate [3] and effective brain ablation technique for the treatment of medication refractory essential tremor (ET) and Parkinson disease’s tremor. There is also preliminary evidence that tcMRgFUS ventral intermediate (Vim) thalamotomy may result in a promising effective treatment option for other tremors [4], including multiple sclerosisassociated tremor [5].
Here, we describe two cases of multiple sclerosis (MS) patients with medication refractory debilitating ET that successfully underwent unilateral Vim tcMRgFUS thalamotomy by using a 1.5 Tesla magnetic resonance (MR) unit for procedure guidance [6].
Methods Case presentation Case 1
Cesare Gagliardo and Paolo Ragonese contributed equally to this work. * Cesare Gagliardo [email protected] 1
Department of Biomedicine, Neuroscience and Advanced Diagnostics—Section of Radiological Sciences, University of Palermo, Via del Vespro, 129, 90127 Palermo, PA, Italy
2
Department of Biomedicine, Neuroscience and Advanced Diagnostics—Section of Neurology, Palermo, Italy
3
Department of Biomedicine, Neuroscience and Advanced Diagnostics—Section of Neurosurgery, Palermo, Italy
A 71-year-old right-handed man, with a family history of tremor, was diagnosed with ET because of the onset of postural and kinetic tremor of both hands when he was 30. Ten years later, successively, the onset of walking difficulties and fatigue, following a complete diagnostic workup, MS was diagnosed. While clinical course was characterized by few relapses with a mild increase of disability (motor and sensory impairment), without cerebellar signs and symptoms, tremor which poorly responded to medical treatm
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