Bilateral MR-Guided Focused Ultrasound Pallidothalamic Tractotomy for Parkinson's Disease With 1-Year Follow-Up

Gallay, Marc N.; Moser, David; Magara, Anouk E.; Haufler, Fabio; Jeanmonod, Daniel

doi:10.3389/fneur.2021.601153

Cited by 42 publications

(38 citation statements)

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“…Additionally, our previous study showed serious postural instability and gait disturbances in two out of 20 patients who received bilateral pallidotomy. In the PD study, bilateral pallidothalamic tractotomy‐induced speech impairment, including hypophonia and dysarthria, in 50% of patients 9 . In the present study, hypophonia, and dysarthria were relatively often even after unilateral pallidothalamic tractotomy.…”

Section: Discussionsupporting

confidence: 50%

“…Ablation of the isolated subthalamic nucleus for cervical dystonia has not been reported. Magnetic resonance‐guided focused ultrasound (MRgFUS), which makes focal lesioning without skin incision, is also available for pallidothalamic tract ablation 6,9 . However, possible complications associated with target ablation by MRgFUS are considered the same as those of radiofrequency ablation 6,8,10 .…”

Section: Discussionmentioning

confidence: 99%

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Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Horisawa

Kohara

Nonaka

et al. 2022

Ann Clin Transl Neurol

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Background Neurosurgical ablation of Forel's field H1 for cervical dystonia, which is currently abandoned, was formerly used in the 1960s–1970s. Regardless of the lack of neuroimaging modalities and objective evaluation scales, the reported efficacy was significant. Although recent studies have reappraised the ablation of the pallidothalamic tract at Forel's field H1 for Parkinson's disease, the efficacy for cervical dystonia has not been investigated well. Methods Data of 35 patients with cervical dystonia who underwent unilateral pallidothalamic tractotomy at Forel's field H1 were retrospectively analyzed. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores, the neck score of the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), and adverse events were evaluated preoperatively and at the last available follow‐up period. Results The mean clinical follow‐up period was 13.9 ± 6.5 months. The mean TWSTRS total scores were 34.3 ± 14.0 preoperatively and 18.4 ± 16.5 at the last available follow‐up period (46.4% improvement, p < 0.0001). The BFMDRS neck score also improved significantly from 6.2 ± 2.9 preoperatively to 2.8 ± 2.8 at the last available follow‐up period (55.0% improvement on the neck score, p < 0.0001). Reduced hand dexterity in seven patients, hypophonia in five patients, dysarthria in four patients, and executive dysfunction in one patient were confirmed as adverse events at the last available follow‐up evaluation. One patient had postoperative hemorrhage. Conclusion The current study confirmed significant improvement in TWSTRS total scores and BFMDRS neck scores at the 13.9‐month follow‐up after unilateral pallidothalamic tractotomy. The pallidothalamic tract in Forel's field H1 is expected to be an alternative treatment target for cervical dystonia.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Horisawa

Kohara

Nonaka

et al. 2022

Ann Clin Transl Neurol

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“…The Magnetic Resonance-guided high-intensity Focused Ultrasound (MRgFUS) is a new non-invasive neurosurgical procedure for improving parkinsonian tremor (55)(56)(57). It has been demonstrated to be safe and effective, at least not inferior to unilateral DBS (58), thus, providing clinicians with the choice for different options for a more appropriate intervention based on the features of the individual patients.…”

Section: Discussionmentioning

confidence: 99%

Resting State Functional Connectivity Signatures of MRgFUS Vim Thalamotomy in Parkinson's Disease: A Preliminary Study

et al. 2022

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Magnetic Resonance-guided high-intensity Focused Ultrasound (MRgFUS) of the thalamic ventral intermediate nucleus (Vim) for tremor has increasingly gained interest as a new non-invasive alternative to standard neurosurgery. Resting state functional connectivity (rs-FC) correlates of MRgFUS have not been extensively investigated yet. A region of interest (ROI)-to-ROI rs-FC MRI “connectomic” analysis focusing on brain regions relevant for tremor was conducted on 15 tremor-dominant patients with Parkinson's disease who underwent MRgFUS. We tested whether rs-FC between tremor-related areas was modulated by MRgFUS at 1 and 3 months post-operatively, and whether such changes correlated with individual clinical outcomes assessed by the MDS-UPDRS-III sub items for tremor. Significant increase in FC was detected within bilateral primary motor (M1) cortices, as well as between bilateral M1 and crossed primary somatosensory cortices, and also between pallidum and the dentate nucleus of the untreated hemisphere. Correlation between disease duration and FC increase at 3 months was found between the putamen of both cerebral hemispheres and the Lobe VI of both cerebellar hemispheres, as well as between the Lobe VI of untreated cerebellar hemisphere with bilateral supplementary motor area (SMA). Drop-points value of MDS-UPDRS at 3 months correlated with post-treatment decrease in FC, between the anterior cingulate cortex and bilateral SMA, as well as between the Lobe VI of treated cerebellar hemisphere and the interpositus nucleus of untreated cerebellum. Tremor improvement at 3 months, expressed as percentage of intra-subject MDS-UPDRS changes, correlated with FC decrease between bilateral occipital fusiform gyrus and crossed Lobe VI and Vermis VI. Good responders (≥50% of baseline tremor improvement) showed reduced FC between bilateral SMA, between the interpositus nucleus of untreated cerebellum and the Lobe VI of treated cerebellum, as well as between the untreated SMA and the contralateral putamen. Good responders were characterized at baseline by crossed hypoconnectivity between bilateral putamen and M1, as well as between the putamen of the treated hemisphere and the contralateral SMA. We conclude that MRgFUS can effectively modulate brain FC within the tremor network. Such changes are associated with clinical outcome. The shifting mode of integration among the constituents of this network is, therefore, susceptible to external redirection despite the chronic nature of PD.

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“…An inherent limitation of the procedure is its unilaterality. There are no reports on staged campotomy for other types of dystonia, unlike in PD, dystonic camptocormia, and Meige’s syndrome [ 22 , 23 , 24 , 25 ]. Another factor to consider is the progression of the disease itself.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Magnetic Resonance-Guided Focused Ultrasound in X-Linked Dystonia-Parkinsonism

Jamora

Chang

Taira

2021

Life

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X-linked dystonia-parkinsonism (XDP) is a neurodegenerative condition found among males with maternal ancestry from Panay Island, Philippines. The treatment options are limited. We report on our experience of three XDP patients who underwent transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) pallidothalamic tractotomy. The three patients were all genetically confirmed XDP, with a mean XDP-Movement Disorder Society of the Philippines (MDSP) Scale score of 68.7/200. All patients were on stable doses of their oral medications and their last botulinum toxin injection was 12 months prior to study. Two patients complained of moderate to severe arm pain 2–7 months after the procedure. There was an overall improvement in the XDP-MDSP Scale score of 36.2% (18.7 vs. 15) at 6 months and 30.1% (68.7 vs. 45.5) at 1 year. Notably, there was worsening of the nonmotor subscale (part IIIB, nonbehavioral aspect) by 350% at 1 year. While these numbers are encouraging, there is a need to do a larger study on the safety and efficacy of tcMRgFUS on XDP.

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Bilateral MR-Guided Focused Ultrasound Pallidothalamic Tractotomy for Parkinson's Disease With 1-Year Follow-Up

Cited by 42 publications

References 42 publications

Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Resting State Functional Connectivity Signatures of MRgFUS Vim Thalamotomy in Parkinson's Disease: A Preliminary Study

Transcranial Magnetic Resonance-Guided Focused Ultrasound in X-Linked Dystonia-Parkinsonism

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