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Movement disorders
Review
Functional lesional neurosurgery for tremor: a systematic review and meta-analysis
  1. Sebastian R Schreglmann1,2,
  2. Joachim K Krauss3,
  3. Jin Woo Chang4,
  4. Kailash P Bhatia2,
  5. Georg Kägi1
  1. 1 Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
  2. 2 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK
  3. 3 Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
  4. 4 Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Dr Georg Kägi, Department of Neurology, Kantonsspital St.Gallen, St.Gallen 9007, Switzerland; georg.kaegi{at}kssg.ch

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.

  • tremor
  • meta-analysis
  • neurosurgery
  • parkinson’s disease
  • systematic reviews

https://doi.org/10.1136/jnnp-2017-316302

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    Footnotes

    • Contributors SRS performed the systematic review, the statistical analysis and wrote the manuscript. JKK and JWC critically reviewed the manuscript. KPB provided input on data analysis and manuscript structure and critically reviewed the manuscript. GK initiated and supervised the project, was involved in the systematic review process and critically reviewed the manuscript. All authors agreed on the final manuscript draft.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.