Chen Jui-Cheng, Lu Ming-Kuei, Chen Chun-Ming, Tsai Chon-Haw
Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Neurology, China Medical University Hsinchu Hospital, Zhubei City, Taiwan; Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan; Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan; Division of Parkinson's Disease and Movement Disorders, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
World Neurosurg. 2023 Mar;171:e464-e470. doi: 10.1016/j.wneu.2022.12.049. Epub 2022 Dec 20.
Magnetic resonance-guided focused ultrasound (MRgFUS) has been applied successfully in treating refractory tremors in Parkinson disease (PD). It generates a precise thermal ablation in a specific nucleus or tract, such as ventral intermediate nucleus (VIM) or pallidothalamic tract (PTT). Despite a single lesion improving parts of the PD symptoms, the feasibility and efficacy of a stepwise dual-lesion in VIM and PTT are yet to be explored.
Three patients with tremor-dominant PD (aged 60.7 ± 6.0 years) received dual-target MRgFUS treatment with a series of primary and secondary outcome measures. The VIM and PTT were navigated based on individual magnetic resonance imaging planning of the brain. The primary outcome measures were the off-status Clinical Rating Scale for Tremor and Unified Parkinson's Disease Rating Scale part III (UPDRS-III). The secondary outcome measures included UPDRS I, II, IV, Hohen and Yahr score, Neuropsychiatry Inventory, Quality of life in PD Rating Scale, Non-Motor Symptoms Scale, and Clinical Global Impression. The baseline data were compared with those acquired 1 day and 1 month following the treatment.
The severity of tremor and motor deficits represented by Clinical Rating Scale for Tremor-part B and UPDRS III were significantly improved (P < 0.05 by nonparametric Mann-Whitney U tests) after dual-target ablations. The nonmotor symptoms investigated by UPDRS II and Non-Motor Symptoms Scale also showed significant improvement at the 1-day and 1-month follow-up. There was no adverse effect except temporary procedure-related headache and dizziness during the treatment.
Stepwise dual-lesion targeting VIM and PTT is a safe and effective MRgFUS therapeutic strategy for patients with PD.
磁共振引导聚焦超声（MRgFUS）已成功应用于治疗帕金森病（PD）的难治性震颤。它能在特定核团或神经束，如腹中间核（VIM）或苍白球丘脑束（PTT）产生精确的热消融。尽管单次损伤可改善部分PD症状，但VIM和PTT分步双靶点损伤的可行性和疗效尚待探索。
3例以震颤为主的PD患者（年龄60.7±6.0岁）接受双靶点MRgFUS治疗，并采用一系列主要和次要结局指标。根据个体脑部磁共振成像规划对VIM和PTT进行定位。主要结局指标为关期震颤临床评分量表和统一帕金森病评定量表第三部分（UPDRS-III）。次要结局指标包括UPDRS I、II、IV、霍恩和雅尔评分、神经精神科问卷、PD生活质量评定量表、非运动症状量表和临床总体印象。将基线数据与治疗后1天和1个月获取的数据进行比较。
双靶点消融后，震颤临床评分量表B部分和UPDRS III所代表的震颤严重程度和运动功能缺损显著改善（非参数曼-惠特尼U检验，P<0.05）。UPDRS II和非运动症状量表所调查的非运动症状在1天和1个月随访时也显示出显著改善。治疗期间除了与操作相关的短暂头痛和头晕外，没有不良反应。
针对VIM和PTT的分步双靶点损伤是一种安全有效的PD患者MRgFUS治疗策略。
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