聚焦超声单侧丘脑切开术与丘脑下切开术治疗难治性帕金森病震颤的比较研究

IF 7.4 1区医学 Q1 CLINICAL NEUROLOGY

Movement Disorders Pub Date : 2025-03-03 DOI:10.1002/mds.30159

Steffen Paschen MD, Elena Natera-Villalba MD, José A. Pineda-Pardo PhD, Marta del Álamo MD, Rafael Rodríguez-Rojas PhD, Johannes Hensler MD, Günther Deuschl PhD, Jose A. Obeso PhD, Ann-Kristin Helmers MD, Raúl Martínez-Fernández PhD

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引用次数: 0

摘要

背景：双侧聚焦超声腹侧丘脑中间切开术（Vim‐FUS）是治疗帕金森病（PD）震颤的有效方法。超声消融丘脑下核（STN‐FUS）已被证明对改善PD的所有主要运动特征有效，包括震颤。目的比较Vim - FUS与STN - FUS对帕金森震颤的控制效果。方法回顾性、双中心研究，纳入2015年6月至2022年8月期间接受单侧Vim - FUS或STN - FUS治疗的连续PD患者。停药状态下，受影响最严重的一侧体位性和/或静息性震颤评分≥2分。主要结果是12个月随访时治疗侧震颤改善的组间差异，包括应答者分析。还收集了安全性、整体运动状态和多巴胺能需求的数据。组间比较采用Bonferroni校正的重复测量方差分析；P <的统计学意义；0.05.结果在这两个地点接受治疗的175例患者中，63例被纳入（23例Vim‐FUS， 40例STN‐FUS）。在基线时，两组在病程（6.7±3.8年vs 6.1±3.4年，P = 0.48）和震颤严重程度（5.7±1.5年vs 5.9±2.5年，P = 0.7）方面相同。虽然4个月时两组患者在震颤方面的获益是相等的（P = 0.15），但STN‐FUS患者在12个月时震颤减少更大（4.4±2.0,95% CI 3.7 - 5.0， Vim‐FUS患者为2.7±3.7,95% CI 1.1-4.3, P = 0.012）。STN‐FUS患者中有47.5%（19/40）的震颤完全消失，而Vim‐FUS患者中有8.7%（2/23）的震颤完全消失(P <；0.01)。大多数不良事件是轻微的（91%），并在12个月内消退。结论stn‐FUS和Vim‐FUS可显著改善难治性PD震颤；然而，丘脑下切开术可能有更大更持久的效果。©2025作者。Wiley期刊有限责任公司代表国际帕金森和运动障碍学会出版的《运动障碍》。

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Comparative Study of Focused Ultrasound Unilateral Thalamotomy and Subthalamotomy for Medication-Refractory Parkinson's Disease Tremor

Background

Unilateral focused ultrasound ventral intermediate thalamotomy (Vim-FUS) is effective in treating Parkinson's disease (PD) tremor. Ultrasound ablation of the subthalamic nucleus (STN-FUS) has demonstrated efficacy in improving all cardinal motor features of PD, including tremor.

Objective

To compare the efficacy in parkinsonian tremor control between Vim-FUS and STN-FUS.

Methods

Retrospective, two-center study including consecutive PD patients with medication-refractory tremor who underwent unilateral Vim-FUS or STN-FUS between June 2015 and August 2022. Patients scored ≥2 for postural and/or resting tremor on the most affected body side in the off-medication state. The primary outcome was the between-group difference in tremor improvement on the treated side at 12-month follow-up, including a responder's analysis. Data regarding safety, global motor status, and dopaminergic requirements were also collected. Group comparisons used repeated measures ANOVA with Bonferroni correction; statistical significance for P < 0.05.

Results

Among 175 patients treated at the two sites, 63 were included (23 Vim-FUS, 40 STN-FUS). At baseline, both groups were equivalent in disease duration (6.7 ± 3.8 vs. 6.1 ± 3.4 years, P = 0.48) and tremor severity (5.7 ± 1.5 vs. 5.9 ± 2.5, P = 0.7). While the benefit in tremor was equivalent between the groups at 4 months (P = 0.15), tremor reduction was greater in STN- FUS patients at 12 months (4.4 ± 2.0, 95% CI 3.7–5.0 compared with 2.7 ± 3.7, 95% CI 1.1–4.3 for Vim-FUS, P = 0.012). In 47.5% (19/40) of STN-FUS patients tremor was completely abolished versus 8.7% (2/23) in Vim-FUS patients (P < 0.01). Most adverse events were mild (91%) and resolved by 12 months.

Conclusions

STN-FUS and Vim-FUS significantly improved medication-refractory PD tremor; however, subthalamotomy might have greater and more sustained effect. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

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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.