Combined Phase II/III, multi-center, prospective, single-blinded trial. Ten (10) patients with essential tremor who previously underwent successful and uncomplicated GK thalamotomy for essential tremor will undergo a contralateral treatment. The incidence of side effects will be determined at 3 months postoperatively, graded per the CTCAE v5 and analyzed by a data safety monitoring board. Upon successful review, this Phase II trial will be converted to a Phase III trial of utility that will enrol 40 additional patients. The primary outcome will be the change in QUEST score at 12 months postoperatively, as well as a patient-reported assessment of Health Utility. Secondary outcomes will include objective tremor, gait and speech assessments (filmed and scored by blinded evaluators), as well as quality of life questionnaires and adverse events questionnaires. Outcomes will be assessed at baseline, as well as 3, 6, 12, 24 and 36 months post-operatively.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
Ablation of contralateral VIM nucleus of thalamus with GK using a frame-based, Gamma Knife Perfexion or Icon unit (Elekta, Stockholm, Sweden).
Toronto Western Hospital, University Health Network
Toronto, Ontario, Canada
RECRUITINGCIUSSS de l'Estrie-CHUS - Hôpital Fleurimont
Sherbrooke, Quebec, Canada
RECRUITINGChange in QUEST Score
Difference in QUEST score between baseline and the 12-month follow-up, with statistical significance defined as p = 0.05 and a minimum clinically important difference (MCID) defined as 5
Time frame: 12 months
Patient-based Assessment of Utility
A patient-reported assessment of utility after 12 months using the question "Knowing what you know now, would you do this treatment again?".
Time frame: 12 months
Gait Assessment (NRS-11)
Patient-reported and blinded observer rating of the patient's ability to walk (Numerical rating scale (NRS-11) from 0 to 10, with 10 being best)
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Gait Assessment (missteps)
Number of missteps in a 6 m standardized tandem walk
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Falls
Number of falls in last month
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Speech Assessment (NRS-11)
Patient-reported and blinded observer rating of the patient's ability to speak (Numerical rating scale (NRS-11) from 0 to 10, with 10 being best)
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Numbness
Incidence of new-onset numbness
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Dysgeusia
Incidence of taste alterations
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Other adverse events
Incidence of other adverse events as classified in the CTCAE
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Tremor (CRST)
Assessment of tremor using the Clinical Rating Scale for Tremor (CRST) parts A (0-88) and B (0-36), higher scores correspond to a worse tremor).
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Quality of life (QUEST)
QUality of life in ESsential Tremor (QUEST) questionnaire (0-100 percent, higher scores correspond to a worse quality of life)
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Quality of life (CRST part C)
Part C of the Clinical Rating Scale for Tremor (CRST) (0-32, higher scores correspond to a worse quality of life)
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
Health Utility (EQ-5D-5L)
Health Utility measured using the EQ-5D-5L and computed using the Canadian preference weights. Values range from 0 to 1, with 1 representing a perfect health.
Time frame: Baseline, post operative month 3, 6, 12, 24, 36
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