Department of Psychology, Adler University, 17 N Dearborn St, Chicago, IL, 60602, USA.
Department of Neurological Sciences, Parkinson's Disease and Movement Disorders Program, Rush University Medical Center, 1725 W Harrison St, Ste 755, Chicago, IL, 60612, USA.
Neurol Sci. 2021 Feb;42(2):553-563. doi: 10.1007/s10072-020-05020-1. Epub 2021 Jan 3.
ExAblate received FDA approval for treatment of a range of movement disorders in 2016, including tremor-dominant Parkinson's disease (TDPD), dyskinetic PD, and essential tremor. This incisionless device allows for magnetic resonance-guided focused ultrasound (MRgFUS) for ablation of several regions of interest. Current studies should aim to measure pre- and post-operative neurocognitive functioning to better understand MRgFUS in PD and how it compares to deep brain stimulation, which has known cognitive risks among certain populations.
PubMed, CINAHL, PsycINFO, and Cochrane Library databases were searched from January 2016 to January 2020. Guidelines for Preferred Reporting Items for Systematic Review and Meta-Analyses were used to review clinical trials comprehensively assessing pre- and post-operative neurocognitive functioning in PD patients undergoing MRgFUS. Due to limited extant literature in this area, TDPD was expanded to PD with severe dyskinesia.
Twenty-two abstracts were reviewed following removal of duplicates. After full-text review of eight articles, only two studies included comprehensive neuropsychological evaluations of PD patients undergoing MRgFUS thalamotomy or pallidotomy. Most excluded studies used only brief cognitive screeners to assess functioning. Cognitive declines appear to be minimal following MRgFUS in PD, with exceptions in verbal fluency and inhibition. These results are limited by sample size and sample diversity.
Significant methodological gaps were inadvertently discovered. Few studies to-date have administered comprehensive neuropsychological batteries to ascertain MRgFUS risks to neurocognitive functioning in PD. Studies must extend beyond brief screeners when assessing PD populations vulnerable to decline. Furthermore, consensus on a comprehensive battery would better serve replicability and the ability to engage in useful meta-analyses.
2016 年，ExAblate 获得了 FDA 批准，可用于治疗一系列运动障碍，包括震颤为主的帕金森病（TDPD）、运动障碍型帕金森病和原发性震颤。这种无切口装置可实现磁共振引导聚焦超声（MRgFUS）消融多个感兴趣区域。目前的研究应旨在测量手术前后的神经认知功能，以更好地了解 PD 中的 MRgFUS 及其与深部脑刺激的比较，后者在某些人群中存在已知的认知风险。
从 2016 年 1 月至 2020 年 1 月，检索了 PubMed、CINAHL、PsycINFO 和 Cochrane Library 数据库。使用系统评价和荟萃分析首选报告项目指南全面审查了临床试验，这些临床试验全面评估了接受 MRgFUS 的 PD 患者手术前后的神经认知功能。由于该领域的文献有限，将 TDPD 扩展到伴有严重运动障碍的 PD。
在去除重复项后，共审查了 22 篇摘要。对 8 篇文章的全文进行审查后，只有两项研究包括对接受 MRgFUS 丘脑切开术或苍白球切开术的 PD 患者进行全面神经心理学评估。大多数排除的研究仅使用简短的认知筛查器来评估功能。认知能力下降似乎在 PD 患者接受 MRgFUS 治疗后很小，言语流畅性和抑制除外。这些结果受到样本量和样本多样性的限制。
无意中发现了重大的方法学差距。迄今为止，很少有研究使用全面的神经心理学电池来确定 MRgFUS 对 PD 神经认知功能的风险。在评估易发生认知能力下降的 PD 人群时，研究必须超越简短的筛查器。此外，对综合电池达成共识将更好地服务于可重复性和进行有用的荟萃分析的能力。
