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Functional Lesional Neurosurgery for Tremor: A Systematic Review and Meta-Analysis

Authors
 Sebastian R Schreglmann  ;  Joachim K Krauss  ;  Jin Woo Chang  ;  Kailash P Bhatia  ;  Georg Kägi 
Citation
 JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, Vol.89(7) : 717-726, 2018-04 
Journal Title
 JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY 
ISSN
 0022-3050 
Issue Date
2018-04
MeSH
Brain Neoplasms / complications ; Brain Neoplasms / surgery* ; Essential Tremor ; Humans ; Multiple Sclerosis / complications ; Multiple Sclerosis / surgery* ; Neurosurgical Procedures* ; Parkinson Disease / complications ; Parkinson Disease / surgery* ; Tremor / etiology ; Tremor / surgery*
Keywords
meta-analysis ; neurosurgery ; parkinson’s disease ; systematic reviews ; tremor
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 peer-reviewed studies reporting 102 cohorts homogeneous for tremor aetiology, surgical target and technique were included.Effect 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.
Full Text
https://jnnp.bmj.com/content/89/7/717.long
DOI
10.1136/jnnp-2017-316302
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Chang, Jin Woo(장진우) ORCID logo https://orcid.org/0000-0002-2717-0101
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175854
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