Sinai Alon, Nassar Maria, Shornikov Lev, Constantinescu Marius, Zaaroor Menashe, Schlesinger Ilana
Department of Neurosurgery, Rambam Health Care Campus, Haifa, Israel.
Department of Neurology, Rambam Health Care Campus, Haifa, Israel.
Parkinsons Dis. 2024 Mar 5;2024:6643510. doi: 10.1155/2024/6643510. eCollection 2024.
Magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) VIM-thalamotomy has established efficacy and safety in tremor relief in patients with essential tremor and Parkinson's disease. The efficacy and safety in patients with atypical parkinsonism have not been reported.
To report on the efficacy and safety of FUS VIM-thalamotomy in 8 patients with parkinsonism, multiple system atrophy-Parkinsonian type (MSA-P) ( = 5), and dementia with Lewy bodies (DLB) ( = 3).
Tremor was assessed in the treated hemibody using the Clinical Rating Scale for Tremor (CRST). The motor Unified MSA Rating Scale (UMSAR) was used in the MSA-P and motor sections of the Unified Parkinson's Disease Rating Scale (UPDRS-III) in DLB patients. Cognition was measured using the Montreal Cognitive Assessment (MoCA).
In MSA-P and DLB patients, there was immediate tremor relief. CRST scores measured on the treated side improved compared to baseline. During the follow-up of up to 1 year tremor reduction persisted. The change in CRST scores at different time points did not reach statistical significance, probably due to the small sample size. Adverse events were transient and resolved within a year.
In our experience, FUS VIM-thalamotomy was effective in patients with MSA-P and DLB. Larger, controlled studies are needed to verify our preliminary observations.
磁共振成像（MRI）引导下的聚焦超声（FUS）丘脑腹中间核切开术在缓解特发性震颤和帕金森病患者的震颤方面已证实其有效性和安全性。非典型帕金森综合征患者的有效性和安全性尚未见报道。
报告FUS丘脑腹中间核切开术对8例帕金森综合征患者的有效性和安全性，其中多系统萎缩帕金森型（MSA-P）患者5例，路易体痴呆（DLB）患者3例。
使用震颤临床评定量表（CRST）对治疗侧半侧身体的震颤进行评估。MSA-P患者使用运动统一MSA评定量表（UMSAR），DLB患者使用统一帕金森病评定量表（UPDRS-III）的运动部分。使用蒙特利尔认知评估量表（MoCA）测量认知功能。
在MSA-P和DLB患者中，震颤立即得到缓解。与基线相比，治疗侧的CRST评分有所改善。在长达1年的随访期间，震颤减轻持续存在。不同时间点CRST评分的变化未达到统计学意义，可能是由于样本量较小。不良事件是短暂的，在1年内得到缓解。
根据我们的经验，FUS丘脑腹中间核切开术对MSA-P和DLB患者有效。需要进行更大规模的对照研究来验证我们的初步观察结果。
