原發性震顫患者接受磁振導航聚焦超音波丘腦燒灼術後之短期與長期腦部結構變化

Abstract

原發性顫抖(Essential tremor)是一種常見的神經科疾病，雖然對健康不致於造成重大危害，但卻足以造成日常生活相當具體的不便，在部分病人也連帶產生社交退縮等心理影響。目前對於原發性顫抖的治療分為藥物及手術兩種方式，藥物治療雖然簡便，但在不少病人身上卻難以達到理想的效果。磁振導航聚焦超音波丘腦燒灼術(MRgFUS thalamotomy)是一種非侵襲性的手術方式，藉由非侵入性的方式在丘腦精準地形成病灶以治療顫抖，目前已經是不少病人替代服藥的治療方式。 要了解原發性顫抖為何能從磁振導航聚焦超音波丘腦燒灼術獲得治療效益，牽涉到對於疾病生理的了解。本研究試圖透過原發性顫抖患者與對照組、原發性顫抖患者磁振導航聚焦超音波丘腦燒灼術術前與術後早期、術後晚期不同時間的比較，探討疾病本身以及聚焦超音波丘腦燒灼對於腦內結構的影響。我們發現原發性顫抖病人與對照組相比，其胼胝體的體積有所不同；另外，經手術治療後，發現病人胼胝體(corpus callosum)及小腦腳出現微結構以及巨觀的體積改變，暗示了疾病的改善伴隨了跨大腦半球訊息傳導的變化，也呼應了目前對於原發性顫抖是一種「神經網絡疾病」(network disease)的觀點。 本研究受限於樣本數及影像分析技術本身的限制，難以完全揭示原發性顫抖的病態生理以及接受丘腦燒灼術後腦部構造與功能的完整變化，尚待其他更完備之研究進行驗證。

Essential tremor (ET) is a common neurological disorder. Although it does not pose a major threat to overall health, it can cause significant inconvenience in daily life and, in some patients, lead to psychological effects such as social withdrawal. Current treatment strategies for ET include both pharmacological and surgical approaches. While medications are convenient, they often fail to produce satisfactory results in many patients. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) thalamotomy is a non-invasive surgical technique that precisely targets and ablates regions in the thalamus to alleviate tremor, and it has become an alternative treatment for patients who do not respond well to medication. Understanding why MRgFUS thalamotomy benefits patients with ET requires insight into the disease’s underlying pathophysiology. This study compares ET patients with healthy controls, as well as pre- and post-operative imaging (early and late phases) of ET patients undergoing MRgFUS thalamotomy, to investigate the structural brain changes associated with both the disease itself and the surgical intervention. We found that compared to healthy controls, ET patients exhibited differences in the volume of the corpus callosum and cerebellar peduncles. Furthermore, both microstructural and macrostructural changes in the corpus callosum and cerebellar peduncles were observed following MRgFUS thalamotomy, suggesting that improvements in tremor may be accompanied by alterations in interhemispheric communication. These findings support the current view that ET may be a "network disease." However, this study is limited by its small sample size and inherent constraints of neuroimaging techniques, and it may not fully capture the pathological mechanisms of ET or the comprehensive structural and functional changes following thalamotomy. Further studies with larger cohorts and advanced imaging methods are warranted to validate these findings.