Stepwise dual-target magnetic resonance-guided focused ultrasound in tremor-dominant Parkinson disease: One-year follow-up

IF 4.5 2区医学 Q1 CLINICAL NEUROLOGY

European Journal of Neurology Pub Date : 2024-09-17 DOI:10.1111/ene.16468

Jui-Cheng Chen, Chun-Ming Chen, Yu Aoh, Ming-Kuei Lu, Chon-Haw Tsai

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引用次数: 0

Abstract

Background and Purpose

Magnetic resonance-guided focused ultrasound (MRgFUS) is a nonsurgical treatment for Parkinson disease (PD). Some selected anatomical structures can be targeted by MRgFUS in PD. However, there is no uniform target yet. We have reported that stepwise dual-target MRgFUS was successfully applied to treat refractory tremors with akinetic–rigid features in PD. It generated two precise thermal ablations in the ventral intermediate nucleus (VIM) and pallidothalamic tract (PTT). Here, we report more PD patients to verify the safety and efficacy of stepwise dual-target MRgFUS.

Methods

Ten tremor-dominant PD patients (mean age = 66.7 ± 3.2 years, eight men) received the stepwise dual-target MRgFUS treatment with a series of primary and secondary outcome measures. The VIM and PTT were navigated based on brain magnetic resonance images. Outcome measures were categorized into primary and secondary assessments. The primary outcome measures consisted of resting tremor, action/kinetic tremor, rigidity, and bradykinesia. Secondary outcome measures encompassed non-motor symptoms scale of PD. Data collected at follow-up time points, including 1 day, 3 months, 6 months, and 1 year posttreatment, were compared with baseline data.

Results

The severity of tremor and motor deficits represented by Clinical Rating Scale for Tremor parts A and B during off-medication status and Unified Parkinson's Disease Rating Scale III on the treated side were significantly improved (p < 0.05 by paired t-test) at 1-year follow-up. At the 1-year follow-up, significant improvement was observed in the non-motor symptoms scale. Additionally, no severe adverse effects were reported, except temporary treatment-related discomfort during the procedure.

Conclusions

In conclusion, stepwise dual-target MRgFUS emerges as a safe and effective therapeutic modality for PD patients, particularly in addressing medication-refractory tremor and akinetic–rigid syndrome.

Abstract Image

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震颤主导型帕金森病的渐进式双目标磁共振引导聚焦超声：一年随访

背景和目的磁共振引导下聚焦超声（MRgFUS）是治疗帕金森病（PD）的一种非手术疗法。磁共振引导聚焦超声可以针对帕金森病的某些特定解剖结构。然而，目前还没有统一的靶点。我们曾报道过将分步双靶点 MRgFUS 成功应用于治疗帕金森病中具有运动性僵直特征的难治性震颤。它在腹侧中间核（VIM）和苍白球丘脑束（PTT）产生了两个精确的热消融。方法10名震颤为主的PD患者（平均年龄=66.7 ± 3.2岁，8名男性）接受了分步双靶点MRgFUS治疗，并进行了一系列主要和次要结局测量。VIM和PTT根据脑磁共振图像进行导航。结果测量分为主要评估和次要评估。主要结果测量包括静止性震颤、动作/运动性震颤、僵直和运动迟缓。次要结果测量包括帕金森病的非运动症状量表。随访时间点收集的数据包括治疗后 1 天、3 个月、6 个月和 1 年，并与基线数据进行比较。结果随访 1 年时，治疗侧在非用药状态下的震颤严重程度和运动障碍（临床震颤评分量表 A 部分和 B 部分）以及统一帕金森病评分量表 III 均有显著改善（配对 t 检验，p < 0.05）。在 1 年的随访中，非运动症状量表也有明显改善。结论：总之，分步双靶点 MRgFUS 是治疗帕金森病的一种安全有效的方法，尤其是在治疗药物难治性震颤和运动僵直综合征方面。

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来源期刊

European Journal of Neurology 医学-临床神经学

CiteScore

9.70

自引率

2.00%

发文量

418

审稿时长

1 months

期刊介绍： The European Journal of Neurology is the official journal of the European Academy of Neurology and covers all areas of clinical and basic research in neurology, including pre-clinical research of immediate translational value for new potential treatments. Emphasis is placed on major diseases of large clinical and socio-economic importance (dementia, stroke, epilepsy, headache, multiple sclerosis, movement disorders, and infectious diseases).