帕金森病患者眼下核的单侧磁共振引导聚焦超声病变：前瞻性研究

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY

Movement Disorders Pub Date : 2024-09-18 DOI:10.1002/mds.30020

Laura Armengou-Garcia MD, Carlos A. Sanchez-Catasus PhD, Iciar Aviles-Olmos MD, PhD, Adolfo Jiménez-Huete MD, PhD, Genoveva Montoya-Murillo PhD, Arantza Gorospe MD, Antonio Martin-Bastida MD, PhD, Lain Hermes Gonzalez-Quarante MD, Jorge Guridi MD, PhD, Maria C. Rodriguez-Oroz MD, PhD

{"title":"帕金森病患者眼下核的单侧磁共振引导聚焦超声病变：前瞻性研究","authors":"Laura Armengou-Garcia MD, Carlos A. Sanchez-Catasus PhD, Iciar Aviles-Olmos MD, PhD, Adolfo Jiménez-Huete MD, PhD, Genoveva Montoya-Murillo PhD, Arantza Gorospe MD, Antonio Martin-Bastida MD, PhD, Lain Hermes Gonzalez-Quarante MD, Jorge Guridi MD, PhD, Maria C. Rodriguez-Oroz MD, PhD","doi":"10.1002/mds.30020","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Unilateral subthalamic nucleus (STN) ablation using magnetic resonance–guided focused ultrasound (MRgFUS) is being explored as a new treatment for asymmetric Parkinson's disease (PD).</p>\n </section>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>The aims were to study the efficacy and safety of this treatment in asymmetric PD patients and to characterize the lesions.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This prospective, single-center, open-label study evaluated asymmetric PD patients at 6 (n = 20) and 12 months (n = 12) after MRgFUS lesion of the STN. The primary outcome was the change in the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Part III (MDS-UPDRS III), score in <i>off</i> medication on the treated side and the adverse events (AEs) at 6-month follow-up. We also evaluated cognitive–neuropsychological changes, self-assessment of clinical improvement, and the correlation of the lesion volume with the motor outcomes.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>On the treated side, the MDS-UPDRS III score (mean difference = 13.8) and the scores in rigidity, bradykinesia, and tremor improved (<i>P</i> < 0.001) throughout the follow-up compared to baseline (at 6 months: rigidity mean difference = 2.8, improvement: 83.5%; bradykinesia mean difference = 6.0, improvement: 69.4%; tremor mean difference = 4.7, improvement: 91.5%). One patient had severe weakness in the treated hemibody, 1 had moderate dyskinesia, and 1 was in moderate confusional state that became mild (weakness) or completely resolved (dyskinesia and confusional state) at 6 months. The rest of the AEs were mild. We observed no clinically relevant changes in cognitive–neuropsychological tests. The percentage of ablation of the STN correlated with the improvement in the total MDS-UPDRS III and contralateral tremor scores (<i>P</i> < 0.05).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Unilateral MRgFUS lesion of the STN resulted in a significant motor improvement. We observed no persistent severe AEs, although mild, mostly transient AEs were frequent. © 2024 The Author(s). <i>Movement Disorders</i> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.</p>\n </section>\n </div>","PeriodicalId":213,"journal":{"name":"Movement Disorders","volume":"39 12","pages":"2230-2241"},"PeriodicalIF":7.4000,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/mds.30020","citationCount":"0","resultStr":"{\"title\":\"Unilateral Magnetic Resonance–Guided Focused Ultrasound Lesion of the Subthalamic Nucleus in Parkinson's Disease: A Prospective Study\",\"authors\":\"Laura Armengou-Garcia MD, Carlos A. Sanchez-Catasus PhD, Iciar Aviles-Olmos MD, PhD, Adolfo Jiménez-Huete MD, PhD, Genoveva Montoya-Murillo PhD, Arantza Gorospe MD, Antonio Martin-Bastida MD, PhD, Lain Hermes Gonzalez-Quarante MD, Jorge Guridi MD, PhD, Maria C. Rodriguez-Oroz MD, PhD\",\"doi\":\"10.1002/mds.30020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Unilateral subthalamic nucleus (STN) ablation using magnetic resonance–guided focused ultrasound (MRgFUS) is being explored as a new treatment for asymmetric Parkinson's disease (PD).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Objectives</h3>\\n \\n <p>The aims were to study the efficacy and safety of this treatment in asymmetric PD patients and to characterize the lesions.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This prospective, single-center, open-label study evaluated asymmetric PD patients at 6 (n = 20) and 12 months (n = 12) after MRgFUS lesion of the STN. The primary outcome was the change in the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Part III (MDS-UPDRS III), score in <i>off</i> medication on the treated side and the adverse events (AEs) at 6-month follow-up. We also evaluated cognitive–neuropsychological changes, self-assessment of clinical improvement, and the correlation of the lesion volume with the motor outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>On the treated side, the MDS-UPDRS III score (mean difference = 13.8) and the scores in rigidity, bradykinesia, and tremor improved (<i>P</i> < 0.001) throughout the follow-up compared to baseline (at 6 months: rigidity mean difference = 2.8, improvement: 83.5%; bradykinesia mean difference = 6.0, improvement: 69.4%; tremor mean difference = 4.7, improvement: 91.5%). One patient had severe weakness in the treated hemibody, 1 had moderate dyskinesia, and 1 was in moderate confusional state that became mild (weakness) or completely resolved (dyskinesia and confusional state) at 6 months. The rest of the AEs were mild. We observed no clinically relevant changes in cognitive–neuropsychological tests. The percentage of ablation of the STN correlated with the improvement in the total MDS-UPDRS III and contralateral tremor scores (<i>P</i> < 0.05).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Unilateral MRgFUS lesion of the STN resulted in a significant motor improvement. We observed no persistent severe AEs, although mild, mostly transient AEs were frequent. © 2024 The Author(s). <i>Movement Disorders</i> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.</p>\\n </section>\\n </div>\",\"PeriodicalId\":213,\"journal\":{\"name\":\"Movement Disorders\",\"volume\":\"39 12\",\"pages\":\"2230-2241\"},\"PeriodicalIF\":7.4000,\"publicationDate\":\"2024-09-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/mds.30020\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Movement Disorders\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/mds.30020\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Movement Disorders","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/mds.30020","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

背景使用磁共振引导下聚焦超声（MRgFUS）进行单侧丘脑下核（STN）消融正被探索作为治疗非对称性帕金森病（PD）的一种新疗法。这项前瞻性、单中心、开放标签研究评估了 STN MRgFUS 损伤后 6 个月（20 人）和 12 个月（12 人）的非对称帕金森病患者。主要结果是运动障碍协会-统一帕金森病评定量表第三部分（MDS-UPDRS III）的变化、治疗侧停药评分以及随访6个月时的不良事件（AEs）。我们还评估了认知-神经心理学变化、临床改善的自我评估以及病变体积与运动结果的相关性。结果与基线相比，治疗侧的 MDS-UPDRS III 评分（平均差 = 13.8）以及僵直、运动迟缓和震颤评分在整个随访期间均有所改善（P < 0.001）（6 个月时：僵直平均差 = 2.8，改善率：83.5%；运动迟缓平均差 = 6.0，改善率：69.4%；震颤平均差 = 6.0，改善率：69.4%）：69.4%；震颤平均差异 = 4.7，改善率：91.5%）。1 名患者接受治疗的半身出现严重无力，1 名患者出现中度运动障碍，1 名患者出现中度精神错乱，这些症状在 6 个月后变得轻微（无力）或完全消失（运动障碍和精神错乱）。其余不良反应均为轻微。我们在认知神经心理学测试中未观察到临床相关的变化。STN 消融的百分比与 MDS-UPDRS III 和对侧震颤总评分的改善相关（P < 0.05）。我们没有观察到持续的严重不良反应，但轻微的、主要是短暂的不良反应时有发生。© 2024 The Author(s).运动障碍》由 Wiley Periodicals LLC 代表国际帕金森和运动障碍协会出版。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Unilateral Magnetic Resonance–Guided Focused Ultrasound Lesion of the Subthalamic Nucleus in Parkinson's Disease: A Prospective Study

查看原文本刊更多论文

Unilateral Magnetic Resonance–Guided Focused Ultrasound Lesion of the Subthalamic Nucleus in Parkinson's Disease: A Prospective Study

Background

Unilateral subthalamic nucleus (STN) ablation using magnetic resonance–guided focused ultrasound (MRgFUS) is being explored as a new treatment for asymmetric Parkinson's disease (PD).

Objectives

The aims were to study the efficacy and safety of this treatment in asymmetric PD patients and to characterize the lesions.

Methods

This prospective, single-center, open-label study evaluated asymmetric PD patients at 6 (n = 20) and 12 months (n = 12) after MRgFUS lesion of the STN. The primary outcome was the change in the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Part III (MDS-UPDRS III), score in off medication on the treated side and the adverse events (AEs) at 6-month follow-up. We also evaluated cognitive–neuropsychological changes, self-assessment of clinical improvement, and the correlation of the lesion volume with the motor outcomes.

Results

On the treated side, the MDS-UPDRS III score (mean difference = 13.8) and the scores in rigidity, bradykinesia, and tremor improved (P < 0.001) throughout the follow-up compared to baseline (at 6 months: rigidity mean difference = 2.8, improvement: 83.5%; bradykinesia mean difference = 6.0, improvement: 69.4%; tremor mean difference = 4.7, improvement: 91.5%). One patient had severe weakness in the treated hemibody, 1 had moderate dyskinesia, and 1 was in moderate confusional state that became mild (weakness) or completely resolved (dyskinesia and confusional state) at 6 months. The rest of the AEs were mild. We observed no clinically relevant changes in cognitive–neuropsychological tests. The percentage of ablation of the STN correlated with the improvement in the total MDS-UPDRS III and contralateral tremor scores (P < 0.05).

Conclusion

Unilateral MRgFUS lesion of the STN resulted in a significant motor improvement. We observed no persistent severe AEs, although mild, mostly transient AEs were frequent. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Movement Disorders 医学-临床神经学

CiteScore

13.30

自引率

8.10%

发文量

371

审稿时长

12 months

期刊介绍： Movement Disorders publishes a variety of content types including Reviews, Viewpoints, Full Length Articles, Historical Reports, Brief Reports, and Letters. The journal considers original manuscripts on topics related to the diagnosis, therapeutics, pharmacology, biochemistry, physiology, etiology, genetics, and epidemiology of movement disorders. Appropriate topics include Parkinsonism, Chorea, Tremors, Dystonia, Myoclonus, Tics, Tardive Dyskinesia, Spasticity, and Ataxia.