Functional lesional neurosurgery for tremor

A systematic review and meta-analysis

Sebastian R. Schreglmann, Joachim K. Krauss, JinWoo Chang, Kailash P. Bhatia, Georg Kägi

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Background: This work evaluates the consistency, effect size and incidence of persistent side effects of lesional neurosurgical interventions in the treatment of tremor due to Parkinson's disease (PD), essential tremor (ET), multiple sclerosis (MS) and midbrain lesions. Methods: Systematic review and meta-analysis according to PRISMA-P guidelines. Random effects meta-analysis of standardised mean difference based on a peer-reviewed protocol (PROSPERO no. CRD42016048049). Results: From 1249 abstracts screened, 86 peerreviewed studies reporting 102 cohorts homogeneous for tremor aetiology, surgical target and technique were included. E ffect on PD tremor was better when targeted at the ventral intermediate nucleus (V.im.) by radiofrequency ablation (RF) (Hedge's g: -4.15;) over V.im. by Gamma Knife (GK) (-2.2), subthalamic nucleus (STN) by RF (-1.12) and globus pallidus internus (GPi) by RF (-0.89). For ET MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract (CTT) (-2.35) and V.im. (-2.08) showed similar mean tremor reductions to V.im. ablation by RF (-2.42) or GK (-2.13). In MS V.im. ablation by GK (-1.96) and RF (-1.63) were similarly effective. Mean rates of persistent side effects after unilateral lesions in PD were 12.8% (RF V.im.), 13.6% (RF STN), 9.2% (RF GPi), 0.7% (GK V.im.) and 7.0% (MRIgFUS V.im.). For ET, rates were 9.3% (RF V.im.), 1.8% (GK V.im.), 18.7% (MRIgFUS V.im.) and 0.0% (MRIgFUS CTT), for MS 37.7% (RF V.im.) and for rubral tremor 30.3% (RF V.im.). Conclusion: This meta-analysis quantifies safety, consistency and efficacy of lesional neurosurgical interventions for tremor by target, technique and aetiology.

Original languageEnglish
Pages (from-to)717-726
Number of pages10
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume89
Issue number7
DOIs
Publication statusPublished - 2018 Jul 1

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Neurosurgery
Tremor
Meta-Analysis
Essential Tremor
Multiple Sclerosis
Parkinson Disease
Subthalamic Nucleus
Globus Pallidus
Ataxia
Mesencephalon
Guidelines
Safety
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Schreglmann, Sebastian R. ; Krauss, Joachim K. ; Chang, JinWoo ; Bhatia, Kailash P. ; Kägi, Georg. / Functional lesional neurosurgery for tremor : A systematic review and meta-analysis. In: Journal of Neurology, Neurosurgery and Psychiatry. 2018 ; Vol. 89, No. 7. pp. 717-726.
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abstract = "Background: This work evaluates the consistency, effect size and incidence of persistent side effects of lesional neurosurgical interventions in the treatment of tremor due to Parkinson's disease (PD), essential tremor (ET), multiple sclerosis (MS) and midbrain lesions. Methods: Systematic review and meta-analysis according to PRISMA-P guidelines. Random effects meta-analysis of standardised mean difference based on a peer-reviewed protocol (PROSPERO no. CRD42016048049). Results: From 1249 abstracts screened, 86 peerreviewed studies reporting 102 cohorts homogeneous for tremor aetiology, surgical target and technique were included. E ffect on PD tremor was better when targeted at the ventral intermediate nucleus (V.im.) by radiofrequency ablation (RF) (Hedge's g: -4.15;) over V.im. by Gamma Knife (GK) (-2.2), subthalamic nucleus (STN) by RF (-1.12) and globus pallidus internus (GPi) by RF (-0.89). For ET MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract (CTT) (-2.35) and V.im. (-2.08) showed similar mean tremor reductions to V.im. ablation by RF (-2.42) or GK (-2.13). In MS V.im. ablation by GK (-1.96) and RF (-1.63) were similarly effective. Mean rates of persistent side effects after unilateral lesions in PD were 12.8{\%} (RF V.im.), 13.6{\%} (RF STN), 9.2{\%} (RF GPi), 0.7{\%} (GK V.im.) and 7.0{\%} (MRIgFUS V.im.). For ET, rates were 9.3{\%} (RF V.im.), 1.8{\%} (GK V.im.), 18.7{\%} (MRIgFUS V.im.) and 0.0{\%} (MRIgFUS CTT), for MS 37.7{\%} (RF V.im.) and for rubral tremor 30.3{\%} (RF V.im.). Conclusion: This meta-analysis quantifies safety, consistency and efficacy of lesional neurosurgical interventions for tremor by target, technique and aetiology.",
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Functional lesional neurosurgery for tremor : A systematic review and meta-analysis. / Schreglmann, Sebastian R.; Krauss, Joachim K.; Chang, JinWoo; Bhatia, Kailash P.; Kägi, Georg.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 89, No. 7, 01.07.2018, p. 717-726.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Functional lesional neurosurgery for tremor

T2 - A systematic review and meta-analysis

AU - Schreglmann, Sebastian R.

AU - Krauss, Joachim K.

AU - Chang, JinWoo

AU - Bhatia, Kailash P.

AU - Kägi, Georg

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: This work evaluates the consistency, effect size and incidence of persistent side effects of lesional neurosurgical interventions in the treatment of tremor due to Parkinson's disease (PD), essential tremor (ET), multiple sclerosis (MS) and midbrain lesions. Methods: Systematic review and meta-analysis according to PRISMA-P guidelines. Random effects meta-analysis of standardised mean difference based on a peer-reviewed protocol (PROSPERO no. CRD42016048049). Results: From 1249 abstracts screened, 86 peerreviewed studies reporting 102 cohorts homogeneous for tremor aetiology, surgical target and technique were included. E ffect on PD tremor was better when targeted at the ventral intermediate nucleus (V.im.) by radiofrequency ablation (RF) (Hedge's g: -4.15;) over V.im. by Gamma Knife (GK) (-2.2), subthalamic nucleus (STN) by RF (-1.12) and globus pallidus internus (GPi) by RF (-0.89). For ET MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract (CTT) (-2.35) and V.im. (-2.08) showed similar mean tremor reductions to V.im. ablation by RF (-2.42) or GK (-2.13). In MS V.im. ablation by GK (-1.96) and RF (-1.63) were similarly effective. Mean rates of persistent side effects after unilateral lesions in PD were 12.8% (RF V.im.), 13.6% (RF STN), 9.2% (RF GPi), 0.7% (GK V.im.) and 7.0% (MRIgFUS V.im.). For ET, rates were 9.3% (RF V.im.), 1.8% (GK V.im.), 18.7% (MRIgFUS V.im.) and 0.0% (MRIgFUS CTT), for MS 37.7% (RF V.im.) and for rubral tremor 30.3% (RF V.im.). Conclusion: This meta-analysis quantifies safety, consistency and efficacy of lesional neurosurgical interventions for tremor by target, technique and aetiology.

AB - Background: This work evaluates the consistency, effect size and incidence of persistent side effects of lesional neurosurgical interventions in the treatment of tremor due to Parkinson's disease (PD), essential tremor (ET), multiple sclerosis (MS) and midbrain lesions. Methods: Systematic review and meta-analysis according to PRISMA-P guidelines. Random effects meta-analysis of standardised mean difference based on a peer-reviewed protocol (PROSPERO no. CRD42016048049). Results: From 1249 abstracts screened, 86 peerreviewed studies reporting 102 cohorts homogeneous for tremor aetiology, surgical target and technique were included. E ffect on PD tremor was better when targeted at the ventral intermediate nucleus (V.im.) by radiofrequency ablation (RF) (Hedge's g: -4.15;) over V.im. by Gamma Knife (GK) (-2.2), subthalamic nucleus (STN) by RF (-1.12) and globus pallidus internus (GPi) by RF (-0.89). For ET MRI-guided focused ultrasound (MRIgFUS) ablation of the cerebellothalamic tract (CTT) (-2.35) and V.im. (-2.08) showed similar mean tremor reductions to V.im. ablation by RF (-2.42) or GK (-2.13). In MS V.im. ablation by GK (-1.96) and RF (-1.63) were similarly effective. Mean rates of persistent side effects after unilateral lesions in PD were 12.8% (RF V.im.), 13.6% (RF STN), 9.2% (RF GPi), 0.7% (GK V.im.) and 7.0% (MRIgFUS V.im.). For ET, rates were 9.3% (RF V.im.), 1.8% (GK V.im.), 18.7% (MRIgFUS V.im.) and 0.0% (MRIgFUS CTT), for MS 37.7% (RF V.im.) and for rubral tremor 30.3% (RF V.im.). Conclusion: This meta-analysis quantifies safety, consistency and efficacy of lesional neurosurgical interventions for tremor by target, technique and aetiology.

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U2 - 10.1136/jnnp-2017-316302

DO - 10.1136/jnnp-2017-316302

M3 - Review article

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EP - 726

JO - Journal of Neurology, Neurosurgery and Psychiatry

JF - Journal of Neurology, Neurosurgery and Psychiatry

SN - 0022-3050

IS - 7

ER -