Bilateral MR-Guided Focused Ultrasound Pallidothalamic Tractotomy for Parkinson's Disease With 1-Year Follow-Up.
Bilateral MR-Guided Focused Ultrasound Pallidothalamic Tractotomy for Parkinson's Disease With 1-Year Follow-Up.
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DOI：
10.3389/fneur.2021.601153
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发表时间：
2021
影响因子：
3.4
通讯作者：
Jeanmonod D
中科院分区：
文献类型：
--
作者：
Gallay MN;Moser D;Magara AE;Haufler F;Jeanmonod D
目的：双侧立体定向神经外科治疗晚期帕金森病 (PD) 有着悠久的历史，始于 20 世纪 40 年代末。鉴于提高病变准确性和降低出血风险，尽管长期以来对双侧方法存在警告，但仍有必要研究双侧 MR 引导聚焦超声 (MRgFUS) 干预措施。我们在此介绍双侧苍白球丘脑束切开术 (PTT) 的临床结果，即在 Forel 视野 H1 水平针对丘脑下方的苍白球传出纤维，在第二侧手术后随访 1 年。方法：10 例接受双侧 PTT 的慢性难治性 PD 患者在第二侧手术后随访 1 年。主要终点包括用药和停药状态下的统一帕金森病评定量表（UPDRS）评分、运动障碍、肌张力障碍、睡眠障碍、疼痛、药物摄入量减少以及患者对她/他的整体症状缓解以及震颤控制的评估。结果：基线 UPDRS 评分与第二侧术后 1 年之间的时间范围为 36 ± 15 个月。与基线用药时相比，第二次 PTT 后 1 年停药后的 UPDRS 总评分降低了 52%（p < 0.007）。与基线用药检查相比，停药 1 年后，震颤平均评分降低 91%（p = 0.006），远端僵直评分降低 67%（p = 0.006），远端运动迟缓评分降低 54%（p = 0.01）。步态和姿势不稳定性与基线相比总体上没有变化（平均改善 13%，p = 0.67，平均减少 5.3%，p = 0.83）。言语困难，即发声减退、语速过快和开始说话，增加了 58% (p = 0.06)。四分之四的患者运动障碍得到抑制，五分之四的患者肌张力障碍得到抑制，四分之三的患者睡眠障碍得到抑制。疼痛减轻了 89%。平均左旋多巴摄入量从 690 ± 250 减少到 110 ± 190。 结论：我们的结果表明，与基线时的最佳药物治疗相比，双侧 PTT 在控制震颤、远端强直、远端运动迟缓、运动障碍、肌张力障碍和疼痛方面具有效率。当然需要更大的系列。
Objective: Bilateral stereotactic neurosurgery for advanced Parkinson's disease (PD) has a long history beginning in the late 1940s. In view of improved lesioning accuracy and reduced bleeding risk and in spite of long-standing caveats about bilateral approaches, there is a need to investigate bilateral MR-guided focused ultrasound (MRgFUS) interventions. We hereby present the clinical results of bilateral pallidothalamic tractotomy (PTT), i.e., targeting of pallidal efferent fibers below the thalamus at the level of Forel's field H1, followed for 1 year after operation of the second side. Methods: Ten patients suffering from chronic and therapy-resistant PD having received bilateral PTT were followed for 1 year after operation of the second side. The primary endpoints included the Unified Parkinson's Disease Rating Scale (UPDRS) scores in on- and off-medication states, dyskinesias, dystonia, sleep disturbances, pain, reduction in drug intake, and assessment by the patient of her/his global symptom relief as well as tremor control. Results: The time frame between baseline UPDRS score and 1 year after the second side was 36 ± 15 months. The total UPDRS score off-medication at 1 year after the second PTT was reduced by 52% compared to that at baseline on-medication (p < 0.007). Percentage reductions of the mean scores comparing 1 year off- with baseline on-medication examinations were 91% for tremor (p = 0.006), 67% for distal rigidity (p = 0.006), and 54% for distal hypobradykinesia (p = 0.01). Gait and postural instability were globally unchanged to baseline (13% improvement of the mean, p = 0.67, and 5.3% mean reduction, p = 0.83). Speech difficulties, namely, hypophonia, tachyphemia, and initiation of speech, were increased by 58% (p = 0.06). Dyskinesias were suppressed in four over four, dystonia in four over five, and sleep disorders in three over four patients. There was 89% pain reduction. Mean L-Dopa intake was reduced from 690 ± 250 to 110 ± 190. Conclusions: Our results suggest an efficiency of bilateral PTT in controlling tremor, distal rigidity, distal hypobradykinesia, dyskinesias, dystonia, and pain when compared to best medical treatment at baseline. Larger series are of course needed.
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影响因子：
9.9
作者：
Aarsland, D;Andersen, K;Kragh-Sorensen, P
通讯作者：
Kragh-Sorensen, P
影响因子：
1.8
作者：
Gallay, Marc N.;Moser, David;Jeanmonod, Daniel
通讯作者：
Jeanmonod, Daniel
影响因子：
4.8
作者：
Favre, J;Burchiel, KJ;Hammerstad, J
通讯作者：
Hammerstad, J
影响因子：
1.8
作者：
Gallay, Marc N.;Moser, David;Jeanmonod, Daniel
通讯作者：
Jeanmonod, Daniel
影响因子：
25
作者：
Benedetti, F;Colloca, L;Lopiano, L
通讯作者：
Lopiano, L