Fibrinogen and hypertension are key factors associated with tremor relieve and recurrence in the ET patients subjected with MRgFUS thalamotomy

ObjectiveMagnetic resonance guided focused ultrasound (MRgFUS) thalamotomy has been shown to be safe and effective to treat various types of tremor diseases, but whether the clinical status of these patients was involved was still unknown. MethodsWe retrospectively studied the tremor symptoms and clinical variables (at hospitalization) of 59 essential tremor (ET) patients subjected with MRgFUS thalamotomy. Patients were categorized by the short-term tremor relieve and tremor recurrence within 12 months. Multivariate logistic regression was used to screen independent factors and construct the nomograms. Additional fibrinogen knock-out mice were applied to establish ET mouse model induced by harmaline and the frequency and intensity of tremor were measured and analyzed using a force-plated accelerometer. ResultsIt is found that 39 ET patients (66.102%) with significantly better efficiency in short-term tremor relieve (control ratio > 75%) at 1-month postoperatively, while nine ET patients (15.254%) experienced significant tremor recurrence within postoperative one-year. Multivariate analysis suggested fibrinogen (OR = 0.182, 95% CI = 0.042-0.796,) and monocyte count (OR = 0, 95% CI = 0-0.001) were independently associated with better short-term tremor relieve (>75%) at 1-month postoperatively. A total of nine ET patients (15.254%) experienced significant tremor recurrence. Admission systolic blood pressure (OR = 1.013, 95% CI = 1.010-1.062), hypertension comorbidity (OR = 2.163, 95% CI = 1.412-53.565) and fibrinogen (OR = 1.620, 95% CI = 1.047-24.376) independently contributed to tremor recurrence. The nomograms were established for better tremor relieve and tremor recurrence and have excellent performance as the AUCs were 0.829 and 0.853 (bootstrap repetition = 1000). Moreover, fibrinogen knock-out promoted a great suppression on maximum tremor motion power and overall tremor activity in ET tremor model (P < 0.001). ConclusionsThe study found that baseline fibrinogen is the key factor associated with tremor relieve and recurrence for patients subjected with MRgFUS thalamotomy. Preoperative evaluation of clinical factors has important predictive significance for short- and long-term postoperative outcomes for patients treated with MRgFUS thalamotomy.