Fasano Alfonso, Lozano Andres M, Cubo Esther
aMorton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital bDivision of Neurology, University of Toronto cKrembil Research Institute dDivision of Neurosurgery, University of Toronto eDepartment of Surgery, Toronto Western Hospital, Toronto, Otario, Canada fNeurology Department, Hospital Universitario Burgos, Burgos, Spain.
Curr Opin Neurol. 2017 Aug;30(4):435-446. doi: 10.1097/WCO.0000000000000465.
The objective of this review is to gather the newest advances in the surgical treatment of tremor and Parkinson's disease. We will briefly discuss the potential applications of the new technologies of deep brain stimulation (DBS), and we will focus on MRI-guided focused ultrasound (MRgFUS).
Novel DBS devices are being progressively adopted, particularly electrodes allowing a longer stimulating surface (suitable for multiple targets stimulation) and current radial steering (to minimize side effects of stimulation). New implantable pulse generators are also able to record neurons and are generating enough knowledge to advance the implementation of adaptive (closed-loop) DBS.Over the last years, 'minimally-invasive' neurosurgical approaches for the treatment of movement disorders have been developed: gamma knife radiosurgery and MRgFUS. Uncontrolled and recent controlled studies have shown the benefits of MRgFUS targeting the thalamus and pallidus for the treatment of tremor and Parkinson's disease.
The initial clinical data are certainly promising and have expanded the current portfolio of neurosurgical treatments of movement disorders. Many issues are yet to be addressed, particularly safety of MRgFUS-and how these new treatments compare with the existing ones.
本综述的目的是收集震颤和帕金森病外科治疗的最新进展。我们将简要讨论深部脑刺激（DBS）新技术的潜在应用，并重点关注磁共振成像引导聚焦超声（MRgFUS）。
新型DBS设备正逐渐被采用，特别是那些具有更长刺激表面（适用于多靶点刺激）和电流径向控制（以最小化刺激副作用）的电极。新型植入式脉冲发生器还能够记录神经元，并积累了足够的知识来推动自适应（闭环）DBS的应用。在过去几年中，已经开发出用于治疗运动障碍的“微创”神经外科方法：伽玛刀放射外科和MRgFUS。非对照和近期的对照研究表明，MRgFUS靶向丘脑和苍白球治疗震颤和帕金森病具有益处。
初步临床数据确实很有前景，并扩大了当前运动障碍神经外科治疗的方法。许多问题仍有待解决，特别是MRgFUS的安全性，以及这些新治疗方法与现有方法的比较。
