双侧聚焦超声苍白球毁损术治疗帕金森病相关面部异动症——病例报告
Bilateral Focused Ultrasound Pallidotomy for Parkinson-Related Facial Dyskinesia-A Case Report.
作者信息
Stieglitz Lennart H, Mahendran Sujitha, Oertel Markus F, Baumann Christian R
机构信息
Department of Neurosurgery University Hospital Zurich Zurich Switzerland.
Department of Neurology University Hospital Zurich Zurich Switzerland.
出版信息
Mov Disord Clin Pract. 2022 May 9;9(5):647-651. doi: 10.1002/mdc3.13462. eCollection 2022 Jul.
BACKGROUND
For safety reasons, both magnetic resonance-guided high-intensity focused ultrasound (MRgHiFUS) thalamotomy and pallidotomy are currently approved exclusively for unilateral treatment, but axial symptoms like levodopa-induced orofacial dyskinesia require a bilateral approach.
OBJECTIVES
We report the first case of successful bilateral MRgHiFUS pallidotomy for peak-dose dyskinesia in a patient with Parkinson's disease (PD).
METHODS
The treatment decision was based on the patient's reluctance toward brain implants and pump therapies and the fact that he had limited access to a deep brain stimulation center in his home country. The treatment was planned as staged procedure with an interval of 18 months because of travel restrictions because of the coronavirus disease (COVID)-19 pandemic.
RESULTS
After the second treatment, levodopa-induced orofacial dyskinesia remitted and improved bradykinesia and rigidity with stable gait and good postural reflexes.
CONCLUSIONS
This promising result suggests that in selected PD patients with dyskinesia, staged bilateral MRgHiFUS pallidotomy might be considered.
背景
出于安全考虑，目前磁共振引导下的高强度聚焦超声（MRgHiFUS）丘脑切开术和苍白球切开术仅被批准用于单侧治疗，但左旋多巴诱发的口面部运动障碍等轴向症状需要双侧治疗。
目的
我们报告首例帕金森病（PD）患者成功接受双侧MRgHiFUS苍白球切开术治疗峰值剂量运动障碍的病例。
方法
治疗决策基于患者对脑植入物和泵治疗的抵触，以及他所在国家难以进入深部脑刺激中心这一事实。由于冠状病毒病（COVID）-19大流行导致旅行限制，治疗计划为分阶段进行，间隔18个月。
结果
第二次治疗后，左旋多巴诱发的口面部运动障碍缓解，运动迟缓及僵直改善，步态稳定，姿势反射良好。
结论
这一有前景的结果表明，对于部分患有运动障碍的PD患者，可考虑分阶段进行双侧MRgHiFUS苍白球切开术。
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