The research focus and frontiers in surgical treatment of essential tremor

Abstract

Background: Essential tremor (ET) is one of the most prevalent neurodegenerative disorders, with surgery serving as the principal treatment option. This paper presents a bibliometric analysis of research in the field of ET surgery from 2004 to 2024, aiming to identify current research hotspots and inform future research directions.

Methods: This study employs CiteSpace to analyze publication trends, countries/institutions, authors, keywords, and co-cited references in ET surgery, using the Web of Science core database from 2004 to 2024 to delineate the research pathways.

Results: A total of 1,362 publications were included in this study. The number of publications has shown steady growth over the analyzed period from 2004 to 2024. Research in this field was carried out in 58 countries and by 371 institutions. The United States had the highest volume of publications, with the University of California System identified as the most prolific institution. Dr. Michael S. Okun from the University of Florida was the most prolific author, also based in the United States. This study identified 879 keywords, with significant citation bursts noted in areas such as the caudal zona incerta, ventral intermediate nucleus, location, and MR-guided focused ultrasound. Among the top ten highly cited articles, five pertained to MR-guided focused ultrasound thalamotomy, two addressed localization techniques, and one focused on surgical targets.

Conclusion: This study employs comprehensive bibliometric and visualization analyses to elucidate the evolution of research and identify emerging hotspots. The identified hotspots are as follows: First, deep brain stimulation (DBS), the most advanced technology in ET surgery, has room for improvement, especially in neuromodulation automation. Second, MR-guided focused ultrasound thalamotomy is a new surgical approach that requires further research on efficacy, safety, and side effect management. Third, novel surgical targets have demonstrated some efficacy, yet further research is essential to validate their effectiveness and safety. Lastly, localization techniques are fundamental to ET surgery, with ongoing efforts directed towards achieving more precise, individualized, and intelligent localization.

Keywords: DBS; MRgFUS; essential tremor; hotspots; surgery.

Figure 1

The flow chart of the study design.

Figure 2

The annual number of global publications and citations.

Figure 3

Country co-occurrence. The colored bar at the top represents the years, with the years increasing from left to right. The publication volume, divided by country/institution, is indicated by the size of the circles. The lines separating the circles represent international collaborations between countries/institutions. The more connections, the closer the cooperation with other countries/institutions. The purple outer ring represents the betweenness centrality, and the thicker the purple outer ring, the greater the betweenness centrality.

Figure 4

Research collaboration map between institutions. The color bar in the lower left corner represents the years, and the deeper the red color of the nodes in the figure, the more recent the year.

Figure 5

Author co-occurrence. The size of the circles represents the number of articles published by the authors, with the circles representing the authors themselves. The lines between the circles represent collaborations between authors. The more intense the collaboration with other authors, the more lines there are.

Figure 6

A network map of co-occurring keywords. Circles represent keywords, with the size of the circles indicating the frequency of keyword occurrence. The lines between nodes indicate that keywords appear together.

Figure 7

Clustering map of co-occurring keywords. The colored areas in the figure represent clusters, and the nodes represent the keywords within the clusters.

Figure 8

The top keywords with the strongest citation bursts. Keyword burst analysis was employed. In the keyword burst analysis, “start” and “end” indicate the time of the burst. “Intensity” refers to the strength of the burst, representing the reliability over time.

Figure 9

Highly-cited publications and co-cited references. In the figure, nodes represent documents. The color of the nodes indicates the publication time of the documents, with darker blue signifying older publications and darker red indicating more recent ones.