Abstract：
Medical treatment for tremors may include beta-blockers, primidone, dopaminergic, and anticholinergic drugs but it frequently leads to pharmacoresistance. Therefore, surgical treatment gained relevance as an alternative for those patients.We aim to evaluate radiosurgical thalamotomy as an effective and safe alternative to manage tremors. Pubmed (MEDLINE), Embase, Web of Science, and the Cochrane Library databases were systematically searched for potential articles that evaluated radiosurgical thalamotomy for the management of tremor. Our analysis included 12 studies with 545 patients, 226 of whom were female. Of these, 64.6% of patients were diagnosed with essential tremor (ET), 34.6% with Parkinson\'s disease (PD), and 0.8% with both ET and PD. The FTM-TRS global score (MD -5.46; 95% CI [-10.44]-[-0.47]; I2 = 52%) and the drawing (MD -1.40; 95% CI [-2.03]-[-0.76]; I2 = 93%), drinking (MD -1.60; 95% CI [-1.82]-[-1.37]; I2 = 40%), and writing (MD -1.51; 95% CI [-1.89]-[-1.13]; I2 = 89%) grades showed significantly lower mean differences, favoring radiosurgical thalamotomy. A pooled proportion of 12% presented with tremor unchanged, while 38% presented with total elimination of tremor. Adverse events included: major paresis, minor paresis, dysarthria, and numbness. Thus, radiosurgical thalamotomy is a safe alternative for tremors resistant to medication, particularly in high-risk patients for RF or DBS procedures. The recommended dose of 130 to 150 Gy is effective and well-tolerated. However, randomized controlled trials (RCTs) are needed to understand the unpredictability of tissue response to radiation.
摘要：
震颤的药物治疗可能包括β受体阻滞剂，普米酮,多巴胺能,和抗胆碱能药物，但它经常导致药物耐药性。因此,手术治疗作为这些患者的替代方案获得了相关性。我们的目标是评估放射外科丘脑切开术作为治疗震颤的有效和安全的替代方法。Pubmed(MEDLINE),Embase,WebofScience,系统搜索CochraneLibrary数据库,寻找评估放射外科丘脑切开术治疗震颤的潜在文章.我们的分析包括12项研究，545名患者，226人是女性。其中,64.6%的患者诊断为特发性震颤(ET),34.6%患有帕金森病（PD），ET和PD均为0.8％。FTM-TRS全局得分(MD-5.46;95%CI[-10.44]-[-0.47];I2=52%)和图纸(MD-1.40;95%CI[-2.03]-[-0.76];I2=93%),饮酒（MD-1.60；95%CI[-1.82]-[-1.37]；I2=40%），和写作（MD-1.51;95％CI[-1.89]-[-1.13];I2=89％）成绩显示出明显较低的平均差异，有利于放射外科丘脑切开术。12%的合并比例表现为震颤不变，而38%的人表现出完全消除的震颤。不良事件包括：严重麻痹，轻微的轻瘫,构音障碍,和麻木。因此，放射外科丘脑切开术是对药物抵抗的震颤的安全选择，特别是在RF或DBS手术的高风险患者中。推荐剂量为130至150Gy是有效且耐受性良好的。然而,需要随机对照试验(RCTs)来了解组织对放射反应的不可预测性.
