Sustained reduction of Essential Tremor with low-power non-thermal transcranial focused ultrasound stimulations in humans.
Accelerometry
Essential Tremor
MR-guidance
Skull Aberration Correction
Transcranial Ultrasound Stimulation
Journal
Brain stimulation
ISSN: 1876-4754
Titre abrégé: Brain Stimul
Pays: United States
ID NLM: 101465726
Informations de publication
Date de publication:
09 May 2024
09 May 2024
Historique:
received:
12
12
2023
revised:
03
05
2024
accepted:
03
05
2024
medline:
12
5
2024
pubmed:
12
5
2024
entrez:
11
5
2024
Statut:
aheadofprint
Résumé
Transcranial ultrasound stimulation (TUS) is a non-invasive brain stimulation technique; when skull aberrations are compensated for, this technique allows, with millimetric accuracy, circumvention of the invasive surgical procedure associated with deep brain stimulation (DBS) and the limited spatial specificity of transcranial magnetic stimulation. /hypothesis: We hypothesize that MR-guided low-power TUS can induce a sustained decrease of tremor power in patients suffering from medically refractive essential tremors. The dominant hand only was targeted, and two anatomical sites were sonicated in this exploratory study: the ventral intermediate nucleus of the thalamus (VIM) and the dentato-rubro-thalamic tract (DRT). Patients (N=9) were equipped with MR-compatible accelerometers attached to their hands to monitor their tremor in real-time during TUS. VIM neurostimulations followed by a low-duty cycle (5%) DRT stimulation induced a substantial decrease in the tremor power in four patients, with a minimum of 89.9% reduction when compared with the baseline power a few minutes after the DRT stimulation. The only patient stimulated in the VIM only and with a low duty cycle (5%) also experienced a sustained reduction of the tremor (up to 93.4%). Four patients (N=4) did not respond. The temperature at target was 37.2 ± 1.4°C compared to 36.8 ± 1.4°C for a 3cm away control point. MR-guided low power TUS can induce a substantial and sustained decrease of tremor power. Follow-up studies need to be conducted to reproduce the effect and better to understand the variability of the response amongst patients. MR thermometry during neurostimulations showed no significant thermal rise, supporting a mechanical effect.
Sections du résumé
BACKGROUND
BACKGROUND
Transcranial ultrasound stimulation (TUS) is a non-invasive brain stimulation technique; when skull aberrations are compensated for, this technique allows, with millimetric accuracy, circumvention of the invasive surgical procedure associated with deep brain stimulation (DBS) and the limited spatial specificity of transcranial magnetic stimulation.
OBJECTIVE
OBJECTIVE
/hypothesis: We hypothesize that MR-guided low-power TUS can induce a sustained decrease of tremor power in patients suffering from medically refractive essential tremors.
METHODS
METHODS
The dominant hand only was targeted, and two anatomical sites were sonicated in this exploratory study: the ventral intermediate nucleus of the thalamus (VIM) and the dentato-rubro-thalamic tract (DRT). Patients (N=9) were equipped with MR-compatible accelerometers attached to their hands to monitor their tremor in real-time during TUS.
RESULTS
RESULTS
VIM neurostimulations followed by a low-duty cycle (5%) DRT stimulation induced a substantial decrease in the tremor power in four patients, with a minimum of 89.9% reduction when compared with the baseline power a few minutes after the DRT stimulation. The only patient stimulated in the VIM only and with a low duty cycle (5%) also experienced a sustained reduction of the tremor (up to 93.4%). Four patients (N=4) did not respond. The temperature at target was 37.2 ± 1.4°C compared to 36.8 ± 1.4°C for a 3cm away control point.
CONCLUSIONS
CONCLUSIONS
MR-guided low power TUS can induce a substantial and sustained decrease of tremor power. Follow-up studies need to be conducted to reproduce the effect and better to understand the variability of the response amongst patients. MR thermometry during neurostimulations showed no significant thermal rise, supporting a mechanical effect.
Identifiants
pubmed: 38734066
pii: S1935-861X(24)00085-8
doi: 10.1016/j.brs.2024.05.003
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of Competing Interest ☐ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ☒The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: IR and YS are employees of Insightec. JFA received a research grant from Insightec for preclinical work on transcranial ultrasound.