Ablative surgery for Parkinson’s disease: Is there still a role for pallidotomy in the deep brain stimulation era?

Spindola, Bruno; Leite, Marco Antônio Araújo; Orsini, Marco; Fonoff, Erich Talamoni; Landeiro, José Alberto; Pessôa, Bruno Lima

doi:10.1016/j.clineuro.2017.04.018

Cited by 14 publications

(12 citation statements)

References 100 publications

(119 reference statements)

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“…Even though they could occur in around 20% of the cases overall, they are transient and disappear after a few months in at least half of the instances. [ 51 ] Serious adverse events such as intracerebral hemorrhage are rare.…”

Section: Esioning S Urgeriesmentioning

confidence: 99%

“…Pallidotomy is safer in those with significant medical comorbidities where risks of general anesthesia are high, or in whom implant surgeries are risky, like immunocompromised individuals. [ 51 ]…”

Section: Esioning S Urgeriesmentioning

confidence: 99%

“…Other lesioning surgeries practiced in the past, such as thalamotomy and subthalamotomy, are rarely done for control of LID in the current era because of concerns regarding efficacy and safety. [ 51 ]…”

Section: Agnetic R Esonance-guided mentioning

confidence: 99%

See 2 more Smart Citations

Surgical treatment of levodopa-induced dyskinesia in parkinson's disease

Krishnan

Pisharady

2017

Ann Indian Acad Neurol

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Section: Esioning S Urgeriesmentioning

confidence: 99%

Section: Esioning S Urgeriesmentioning

confidence: 99%

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Surgical treatment of levodopa-induced dyskinesia in parkinson's disease

Krishnan

Pisharady

2017

Ann Indian Acad Neurol

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“…These limitations make it unsuitable to apply DBS in patients who are immunocompromised or are in situations that make follow-up management difficult. 34 Therefore, lesioning procedures may gain clinical importance as a substitute for or complement to DBS in some cases, or they can be a better option in individualized situations with clinical, social, and financial benefits. 6 Despite its cost-effectiveness, pallidal lesioning by conventional radiofrequency (RF) techniques is less preferred, because of the risks of uncontrollable lesion size and consequent irreversible side effects, including hemorrhage, visual field deficits, and motor weakness.…”

mentioning

confidence: 99%

The efficacy and limits of magnetic resonance–guided focused ultrasound pallidotomy for Parkinson’s disease: a Phase I clinical trial

Jung¹,

Park

Kim³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Recently, MR-guided focused ultrasound (MRgFUS) has emerged as an innovative treatment for numerous neurological disorders, including essential tremor, Parkinson's disease (PD), and some psychiatric disorders. Thus, clinical applications with this modality have been tried using various targets. The purpose of this study was to determine the feasibility, initial effectiveness, and potential side effects of unilateral MRgFUS pallidotomy for the treatment of parkinsonian dyskinesia. METHODS A prospective, nonrandomized, single-arm clinical trial was conducted between December 2013 and May 2016 at a single tertiary medical center. Ten patients with medication-refractory, dyskinesia-dominant PD were enrolled. Participants underwent unilateral MRgFUS pallidotomy using the Exablate 4000 device (InSightec) after providing written informed consent. Patients were serially evaluated for motor improvement, neuropsychological effects, and adverse events according to the 1-year follow-up protocol. Primary measures included the changes in the Unified Parkinson's Disease Rating Scale (UPDRS) and Unified Dyskinesia Rating Scale (UDysRS) scores from baseline to 1 week, 1 month, 3 months, 6 months, and 1 year. Secondary measures consisted of neuropsychological batteries and quality of life questionnaire (SF-36). Technical failure and safety issues were also carefully assessed by monitoring all events during the study period. RESULTS Unilateral MRgFUS pallidotomy was successfully performed in 8 of 10 patients (80%), and patients were followed up for more than 6 months. Clinical outcomes showed significant improvements of 32.2% in the "medication-off" UPDRS part III score (p = 0.018) and 52.7% in UDysRS (p = 0.017) at the 6-month follow-up, as well as 39.1% (p = 0.046) and 42.7% (p = 0.046) at the 1-year follow-up, respectively. These results were accompanied by improvement in quality of life. Among 8 cases, 1 patient suffered an unusual side effect of sonication; however, no patient experienced persistent aftereffects. CONCLUSIONS In the present study, which marks the first Phase I pilot study of unilateral MRgFUS pallidotomy for parkinsonian dyskinesia, the authors demonstrated the efficacy of pallidal lesioning using MRgFUS and certain limitations that are unavoidably associated with incomplete thermal lesioning due to technical issues. Further investigation and long-term follow-up are necessary to validate the use of MRgFUS in clinical practice. Clinical trial registration no.: NCT02003248 (clinicaltrials.gov).

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“…Besides, neuromodulation, such as DBS, represents a high cost for public health care not only in developing countries but also in developed ones 12 Ablative surgeries were long used in the treatment of movement disorders, mainly in Parkinson's disease 13 .…”

Section: Opinionmentioning

confidence: 99%