Overview of management of stereotactic radiosurgery treatment in movement disorder

1Gabrielė Petlinskaitė1, Emilija Stulginskaitė1, Marija Ramanauskaitė1

1Faculty of Medicine, Medical Academy of the Lithuanian University of Health Sciences


Movement disorders are common neurological problems that impairs quality of life. The main treatment for movement disorders, especially tremor, is medication, but after time the treatment becomes ineffective, side effects become apparent. One of the most innovative treatments for tremor is stereotactic radiosurgery – the gamma knife thalamotomy. The first prototype of gamma knife was tested in 1968 by Lars Lexel, the pioneer of stereotactic radiosurgery. Modern studies show that a non-invasive method of treatment is indicated for patients suffering from uncontrolled tremor, for elderly patients, for patients, who have severe comorbidities, such as cardiovascular disease, diabetes, renal insufficiency, and if patients are contraindicated in invasive therapies: deep brain stimulation or radiofrequency ablation. The patient’s desire and choice are also included as an indication for the Gamma Knife Thalamotomy procedure. However, different authors have different views on this method of treatment. The dose of ionizing radiation suggested in the literature varies from 120 Gy to 150 Gy. Still, although different authors choose different target localization techniques, but absolutely everyone agrees that the efficiency of the procedure is achieved only by determining the coordinates of the target in the three-dimensional plane with great precision. One of the most popular methodologies recognized worldwide is the Guyot methodology. After the procedure, patients are followed for an average of half a year. After treatment, most published studies found that more than 80 percent of patients achieved clinical improvement in tremor. The most commonly used scales for the evaluation of tremor are the Unified Parkinson’s Disease Rating Scale, the Clinical Tremor Rating Scale, and the Fahn – Tolosa – Marin Tremor Rating Scale. Complications after stereotactic radiosurgery occur at a frequency of less than 9 percent. In this article, we will review the different indications for gamma knife thalamotomy presented by different authors, as well as the methodology of this procedure and the results obtained in various articles.

Keywords: Tremor; Stereotactic; Radiosurgery; Treatment.