Background: COVID-19 limitations have hindered the implementation of new technologies by preventing proctors from coming to the site.We share our first experience of magnetic resonance imaging(MRI)-guided focused ultr...Background: COVID-19 limitations have hindered the implementation of new technologies by preventing proctors from coming to the site.We share our first experience of magnetic resonance imaging(MRI)-guided focused ultrasound(MRgFUS)treatment with an international remote online proctorship,and develop and evaluate the methodology of remote MRgFUS proctorship.Methods: This single-center,nonrandomized controlled prospective study included 94 patients:27 with essential tremor(ET)and 67 with tremor-dominant Parkinson's disease(PD).The coming of proctors was impossible,so we arranged for the remote participation of proctors from the United Kingdom,Spain,and Israel.A total of 38 patients(40.4%)received telemedicine-proctored treatment(proctor group)and 56 received their treatment independently(solo group).We used the Clinical Rating Scale for Tremor(CRST)for ET patients and the Unified Parkinson's Disease Rating Scale(UPDRS)Part III for PD patients.Results: In patients with ET,success rates were 81.8%(proctor group)and 100%(solo group)(p=0.22).CRST reduction on the treated side was 71.43%[65.83%;80.56%](proctor group)versus 60.87%[53.99;79.58](solo group)(p=0.19).None of the patients showed worsening of tremors within 1 year.In patients with PD,the success rates were 92.6%(proctor group)and 100%(solo group)(p=0.08).The UPDRS Part III improvement was 30.1%(proctor group)versus 39.9%(solo group)(p=0.003).The 1-year recurrence rate was 40%(proctor group)and 17.5%(solo group)(p=0.04).No complications were observed at 6 months.Conclusions: We developed a feasible and safe methodology for telemedicine remote online-proctored MRgFUS treatment.No significant difference was observed between the solo and developed remote proctor protocols in terms of complication rate,effect,and long-term results;however,UPDRS Part III improvement was better in the PD solo group.This study demonstrated that the MRgFUS international proctorship can be performed successfully remotely.展开更多
文摘Background: COVID-19 limitations have hindered the implementation of new technologies by preventing proctors from coming to the site.We share our first experience of magnetic resonance imaging(MRI)-guided focused ultrasound(MRgFUS)treatment with an international remote online proctorship,and develop and evaluate the methodology of remote MRgFUS proctorship.Methods: This single-center,nonrandomized controlled prospective study included 94 patients:27 with essential tremor(ET)and 67 with tremor-dominant Parkinson's disease(PD).The coming of proctors was impossible,so we arranged for the remote participation of proctors from the United Kingdom,Spain,and Israel.A total of 38 patients(40.4%)received telemedicine-proctored treatment(proctor group)and 56 received their treatment independently(solo group).We used the Clinical Rating Scale for Tremor(CRST)for ET patients and the Unified Parkinson's Disease Rating Scale(UPDRS)Part III for PD patients.Results: In patients with ET,success rates were 81.8%(proctor group)and 100%(solo group)(p=0.22).CRST reduction on the treated side was 71.43%[65.83%;80.56%](proctor group)versus 60.87%[53.99;79.58](solo group)(p=0.19).None of the patients showed worsening of tremors within 1 year.In patients with PD,the success rates were 92.6%(proctor group)and 100%(solo group)(p=0.08).The UPDRS Part III improvement was 30.1%(proctor group)versus 39.9%(solo group)(p=0.003).The 1-year recurrence rate was 40%(proctor group)and 17.5%(solo group)(p=0.04).No complications were observed at 6 months.Conclusions: We developed a feasible and safe methodology for telemedicine remote online-proctored MRgFUS treatment.No significant difference was observed between the solo and developed remote proctor protocols in terms of complication rate,effect,and long-term results;however,UPDRS Part III improvement was better in the PD solo group.This study demonstrated that the MRgFUS international proctorship can be performed successfully remotely.
