Neuroscience and Brain Disease Center, China Medical University, Taichung, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Eur J Neurol. 2024 Dec;31(12):e16468. doi: 10.1111/ene.16468. Epub 2024 Sep 17.
Magnetic resonance-guided focused ultrasound (MRgFUS) is a nonsurgical treatment for Parkinson disease (PD). Some selected anatomical structures can be targeted by MRgFUS in PD. However, there is no uniform target yet. We have reported that stepwise dual-target MRgFUS was successfully applied to treat refractory tremors with akinetic-rigid features in PD. It generated two precise thermal ablations in the ventral intermediate nucleus (VIM) and pallidothalamic tract (PTT). Here, we report more PD patients to verify the safety and efficacy of stepwise dual-target MRgFUS.
Ten tremor-dominant PD patients (mean age = 66.7 ± 3.2 years, eight men) received the stepwise dual-target MRgFUS treatment with a series of primary and secondary outcome measures. The VIM and PTT were navigated based on brain magnetic resonance images. Outcome measures were categorized into primary and secondary assessments. The primary outcome measures consisted of resting tremor, action/kinetic tremor, rigidity, and bradykinesia. Secondary outcome measures encompassed non-motor symptoms scale of PD. Data collected at follow-up time points, including 1 day, 3 months, 6 months, and 1 year posttreatment, were compared with baseline data.
The severity of tremor and motor deficits represented by Clinical Rating Scale for Tremor parts A and B during off-medication status and Unified Parkinson's Disease Rating Scale III on the treated side were significantly improved (p < 0.05 by paired t-test) at 1-year follow-up. At the 1-year follow-up, significant improvement was observed in the non-motor symptoms scale. Additionally, no severe adverse effects were reported, except temporary treatment-related discomfort during the procedure.
In conclusion, stepwise dual-target MRgFUS emerges as a safe and effective therapeutic modality for PD patients, particularly in addressing medication-refractory tremor and akinetic-rigid syndrome.
磁共振引导聚焦超声（MRgFUS）是一种治疗帕金森病（PD）的非手术方法。在 PD 中，一些选定的解剖结构可以通过 MRgFUS 进行靶向治疗。然而，目前还没有统一的靶点。我们已经报道，分步双靶点 MRgFUS 成功应用于治疗 PD 中具有运动不能-僵硬特征的难治性震颤。它在腹侧中间核（VIM）和苍白球丘脑束（PTT）中产生了两个精确的热消融。在此，我们报告了更多的 PD 患者，以验证分步双靶点 MRgFUS 的安全性和有效性。
10 例震颤为主的 PD 患者（平均年龄 66.7±3.2 岁，8 例男性）接受了分步双靶点 MRgFUS 治疗，并进行了一系列主要和次要结局评估。VIM 和 PTT 是基于脑磁共振图像进行导航的。结局评估分为主要和次要评估。主要结局评估包括静息性震颤、运动性/运动性震颤、僵硬和运动迟缓。次要结局评估包括 PD 的非运动症状量表。在随访时间点（治疗后 1 天、3 个月、6 个月和 1 年）收集的数据与基线数据进行比较。
在药物治疗状态下，治疗侧的临床震颤评定量表（Clinical Rating Scale for Tremor，CRST）A 和 B 部分以及统一帕金森病评定量表（Unified Parkinson's Disease Rating Scale，UPDRS）III 的震颤和运动障碍严重程度显著改善（配对 t 检验，p<0.05）。在 1 年随访时，非运动症状量表也观察到显著改善。此外，除了在手术过程中出现暂时与治疗相关的不适外，没有报告严重的不良事件。
总之，分步双靶点 MRgFUS 是治疗 PD 患者的一种安全有效的治疗方法，尤其在治疗药物难治性震颤和运动不能-僵硬综合征方面。
