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Pineda-Pardo JA, Martínez-Fernández R, Natera-Villalba E, Ruiz-Yanzi A, Rodríguez-Rojas R, Del Alamo M, Jiménez-Castellanos T, Matarazzo M, Gasca-Salas C, Rascol O, Obeso JA. Skull Density Ratio as Arm-Allocation Parameter for a Controlled Focused Ultrasound Trial in Parkinson's Disease. Mov Disord Clin Pract 2024; 11:825-829. [PMID: 38741245 PMCID: PMC11233930 DOI: 10.1002/mdc3.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/17/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND MR-guided focused ultrasound (FUS) thermoablation is an established therapy for movement disorders. FUS candidates must meet a predefined threshold of skull density ratio (SDR), a parameter that accounts for the efficiency in reaching ablative temperatures. Randomized sham-controlled trials to provide definitive therapeutic evidence employ pure randomization of subjects into active treatment or control arms. The latter design has several general limitations. OBJECTIVE To demonstrate that SDR values are not associated with clinically and demographically relevant variables in patients with Parkinson's disease (PD). This in turn would allow using SDR as an arm-allocation parameter, separating patients who will receive active FUS treatment and best medical management treatment (BMT). METHODS We studied a cohort of 215 PD patients who were candidates for FUS subthalamotomy to determine if the SDR was correlated with demographic or clinical variables that could introduce bias for group allocation in a controlled trial. RESULTS SDR was unassociated with age, gender, and clinical motor features nor with levodopa daily dose in our cohort of PD patients. A negative association with age was found for the female subgroup. CONCLUSIONS Our results show that in a PD population considered for FUS subthalamotomy treatment, the SDR may be a valid group-allocation parameter. This could be considered as the basis for a controlled study comparing FUS subthalamotomy vs BMT.
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Affiliation(s)
- José Angel Pineda-Pardo
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
| | - Raul Martínez-Fernández
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
| | - Elena Natera-Villalba
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
- PhD Medicine Program, Universidad Autonoma de Madrid, Madrid, Spain
| | - Agustina Ruiz-Yanzi
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
| | - Rafael Rodríguez-Rojas
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
- Facultad HM de Ciencias de la Salud de la Universidad Camilo José Cela, Madrid, Spain
| | - Marta Del Alamo
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
| | - Tamara Jiménez-Castellanos
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
- Department of Preventive Medicine, Public Health and Microbiology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Michele Matarazzo
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
| | - Carmen Gasca-Salas
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
- Universidad San Pablo-CEU, Madrid, Spain
| | - Olivier Rascol
- Clinical Investigation Center CIC 1436, NS-Park/F-CRIN Network and NeuroToul COEN Center; Inserm, University of Toulouse 3 and CHU of Toulouse, F-31000, Toulouse, France
| | - José A Obeso
- HM CINAC MADRID (Centro Integral de Neurociencias Abarca Campal). Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- CIBERNED, Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria HM Hospitales, Spain
- Universidad San Pablo-CEU, Madrid, Spain
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Cummins DD, Bernabei JM, Wang DD. Focused Ultrasound for Treatment of Movement Disorders: A Review of Non-Food and Drug Administration Approved Indications. Stereotact Funct Neurosurg 2024; 102:93-108. [PMID: 38368868 DOI: 10.1159/000535621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/30/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION MRI-guided focused ultrasound (FUS) is an incisionless thermo-ablative procedure that may be used to treat medication-refractory movement disorders, with a growing number of potential anatomic targets and clinical applications. As of this article's publication, the only US Food and Drug Administration (FDA)-approved uses of FUS for movement disorders are thalamotomy for essential tremor (ET) and tremor-dominant Parkinson's Disease (PD), and pallidotomy for other cardinal symptoms of PD. We present a state-of-the-art review on all non-FDA approved indications of FUS for movement disorders, beyond the most well-described indications of ET and PD. Our objective was to summarize the safety and efficacy of FUS in this setting and provide a roadmap for future directions of FUS for movement disorders. METHODS A state-of-the-art review was conducted on use of FUS for non-FDA approved movement disorders. All movement disorders excluding FDA-approved uses for ET and PD were included. RESULTS A total of 25 studies on 172 patients were included. In patients with tremor plus dystonia syndromes (n = 6), ventralis intermediate nucleus of the thalamus (VIM)-FUS gave >50% tremor reduction, with no improvement in dystonia and worsened dystonia in 2/6 patients. Ventral-oralis complex (VO)-FUS gave >50% improvement for focal hand dystonia (n = 6) and 100% return to musical performance in musician's dystonia (n = 6). In patients with multiple sclerosis (MS) and tremor (n = 3), improvement in tremor was seen in 2 patients with a favorable skull density ratio; no MS disease change was noted after VIM-FUS. In patients with tremor and comorbid ataxia syndromes (n = 3), none were found to have worsened ataxia after VIM-FUS; all had clinically significant tremor improvement. Subthalamic nucleus (STN)-FUS for PD (n = 49) gave approximately 50% improvement in PD motor symptoms, with dystonia and mild dyskinesias as possible adverse effects. Cerebellothalamic tract (CTT-FUS) for ET (n = 42) gave 55-90% tremor improvement, with gait dysfunction as a rare persistent adverse effect. Pallidothalamic tract (PTT-FUS) for PD (n = 50) gave approximately 50% improvement in motor symptoms, with mild speech dysfunction as a possible adverse effect. CONCLUSION VIM-FUS appeared safe and effective for heterogenous tremor etiologies, and VO-FUS appeared most effective for isolated segmental dystonia. STN-FUS was effective for PD symptom reduction; postoperative dystonia and mild on-medication dyskinesias required medical management. Tractography-based targeting with CTT-FUS for ET and PTT-FUS for PD demonstrated promising early results. Larger prospective trials with long-term follow-up are needed to the evaluate the safety and efficacy non-FDA approved indications for FUS.
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Affiliation(s)
- Daniel D Cummins
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, USA
| | - John M Bernabei
- Department of Neurological Surgery, UCSF, San Francisco, California, USA
| | - Doris D Wang
- Department of Neurological Surgery, UCSF, San Francisco, California, USA
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