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Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, Paulus W. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol 2024; 164:57-99. [PMID: 38852434 DOI: 10.1016/j.clinph.2024.05.007] [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: 10/17/2023] [Revised: 03/02/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders.
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Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA 4391, ENT Team, Paris-Est Créteil University, Créteil, France.
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Talyta Grippe
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Xu P, Wu H, Shen G. Characterization of weakly nonlinear effects in relationship to transducer parameters in focused ultrasound therapy. Med Phys 2024. [PMID: 38935266 DOI: 10.1002/mp.17270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/04/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Focused ultrasound therapy has been widely used for the treatment of various diseases, employing different types of transducers. The focused ultrasound pressure fields inevitably exhibit nonlinear effects, which can influence the ablation region. However, the nonlinear effects exhibit noticeable variations across different applications. The characterization of the nonlinear pressure fields of ultrasound is important for the effective implementation of focused ultrasound therapy. PURPOSE The traditional angular spectrum method (ASM) was extended to accurately and efficiently simulate the propagation of weakly nonlinear ultrasound in heterogeneous mediums of clinical model. The nonlinear effects were further analyzed in relationship to the transducer parameters that are different in various applications. METHODS The pressure fields were simulated using the extended ASM, incorporating calculations for phase aberration in the frequency domain and magnitude compensation in the spatial domain to account for heterogeneous acoustic impedance mismatch. Validation was performed by comparison to k-Wave simulation results using two simplified clinical models, an abdominal soft tissue and a transcranial skull model. The nonlinear effects were then analyzed in relation to the transducer parameters of f-number and effective source area based on the same acoustic output power. The analysis of nonlinear effects was conducted under both homogeneous medium and the clinical models. RESULTS The simulation results demonstrated a maximum error of 3.93% in the calculated harmonic pressure of the abdominal model, and a maximum error of 4.89% within the transcranial model when comparing the extended ASM simulation results to those obtained from k-Wave simulations. The characterization of the nonlinear effects reveals a strong correlation with the transducer parameters. Specifically, the results indicate that the nonlinear effects intensify with an increase in the effective source area and f-number, under the same acoustic output power of the transducer. However, the clinical model also showed an influence on the nonlinear effects in relation to the f-number. CONCLUSION The extended ASM was demonstrated as an accurate and efficient simulation tool, and the simulation results provide a reference for evaluating the intensity of nonlinear effects in various transducer designs.
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Affiliation(s)
- Peng Xu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Hao Wu
- Shanghai Shende Green Medical Era Healthcare Technology Co., Ltd, Shanghai, People's Republic of China
| | - Guofeng Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Cesarano S, Saporito G, Sucapane P, Bruno F, Catalucci A, Pistoia ML, Splendiani A, Ricci A, Di Cesare E, Totaro R, Pistoia F. Staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of bilateral essential tremor and Parkinson's disease related tremor: a systematic review and critical appraisal of current knowledge. Front Neurol 2024; 15:1409727. [PMID: 38966080 PMCID: PMC11223629 DOI: 10.3389/fneur.2024.1409727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 06/12/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction Essential tremor (ET) and Parkinson's Disease (PD) are debilitating neurodegenerative disorders characterized by tremor as a predominant symptom, significantly impacting patients' quality of life. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) Thalamotomy is an innovative therapeutic option for the treatment of unilateral medically refractory tremor with fewer adverse effects compared to traditional surgical interventions. A recent CE approval allows appropriate patients to have their second side treated. Objective The objective of this systematic review was to analyze available current knowledge about the use of MRgFUS for the treatment of bilateral ET and PD related tremor, to identify the effectiveness and the risks associated with bilateral treatment. Methods Eligible studies were identified by searching published studies in PubMed and Scopus databases from May 2014 to January 2024 and by identifying ongoing studies registered on the clinicaltrials.gov website. Data were summarized by considering the following information topics: the number of patients involved, the selected lesion target, the assessment tool used to evaluate clinical changes, the observed improvement, the reported side effects, and the time interval between the two treatments. The study was registered in PROSPERO (ID: CRD42024513178). Results Nine studies were eligible for this review, 7 for ET and 2 for PD. The involved population included a variable number of patients, ranging from 1 to 11 subjects for ET and from 10 to 15 subjects for PD. The main lesional targets were the ventral intermediate nucleus of the thalamus, the pallidothalamic tract and the cerebellothalamic tract bilaterally. All studies investigated the tremor relief through the Clinical Rating Scale for Tremor (CRST) in patients with ET, and through the Unified Parkinson's Disease Rating Scale (UPDRS) in patients with PD. A variable degree of improvement was observed, with all patients expressing overall satisfaction with the bilateral treatment. Adverse events were mild and transient, primarily involving gait disturbances, dysarthria, and ataxia. A standardized protocol for administering the two consecutive treatments was not identifiable; typically, the timing of the second treatment was delayed by at least 6 months. Conclusion Available evidence supports the effectiveness and safety of staged bilateral MRgFUS treatments for ET and PD-related tremor.
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Affiliation(s)
- Simone Cesarano
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Gennaro Saporito
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | | | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, L’Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rocco Totaro
- Department of Neurology, San Salvatore Hospital, L’Aquila, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Neurology, San Salvatore Hospital, L’Aquila, Italy
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Saporito G, Sucapane P, Bruno F, Catalucci A, Masciocchi C, Pistoia ML, Splendiani A, Ricci A, Di Cesare E, Marini C, Mazza M, Totaro R, Pistoia F. Cognitive safety of focused ultrasound thalamotomy for tremor: 1-year follow-up results of the COGNIFUS part 2 study. Front Neurol 2024; 15:1395282. [PMID: 38952468 PMCID: PMC11215051 DOI: 10.3389/fneur.2024.1395282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024] Open
Abstract
Introduction In the COGNitive in Focused UltraSound (COGNIFUS) study, we examined the 6-month cognitive outcomes of patients undergoing MRgFUS thalamotomy. This study endorsed the safety profile of the procedure in terms of cognitive functions that cannot be evaluated in real-time during the procedure unlike other aspects. The aim of the COGNIFUS Part 2 study was to investigate the cognitive trajectory of MRgFUS patients over a 1-year period, in order to confirm long-term safety and satisfaction. Methods We prospectively evaluated the cognitive and neurobehavioral profile of patients with essential tremor (ET) or Parkinson's Disease (PD) related tremor undergoing MRgFUS thalamotomy at 1 year-follow-up following the treatment. Results The sample consists of 50 patients (male 76%; mean age ± SD 69.0 ± 8.56; mean disease duration ± SD 12.13 ± 12.59; ET 28, PD 22 patients). A significant improvement was detected at the 1 year-follow-up assessment in anxiety and mood feelings (Hamilton Anxiety rating scale 5.66 ± 5.02 vs. 2.69 ± 3.76, p ≤ <0.001; Beck depression Inventory II score 3.74 ± 3.80 vs. 1.80 ± 2.78, p = 0.001), memory domains (Rey Auditory Verbal Learning Test, immediate recall 31.76 ± 7.60 vs. 35.38 ± 7.72, p = 0.001 and delayed recall scores 5.57 ± 2 0.75 vs. 6.41 ± 2.48), frontal functions (Frontal Assessment Battery score 14.24 ± 3.04 vs. 15.16 ± 2.74) and in quality of life (Quality of life in Essential Tremor Questionnaire 35.00 ± 12.08 vs. 9.03 ± 10.64, p ≤ 0.001 and PD Questionnaire -8 7.86 ± 3.10 vs. 3.09 ± 2.29, p ≤ 0.001). Conclusion Our study supports the long-term efficacy and cognitive safety of MRgFUS treatment for ET and PD.
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Affiliation(s)
- Gennaro Saporito
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Neurology, San Salvatore Hospital, L’Aquila, Italy
| | | | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, L’Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Carmine Marini
- Department of Internal Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Monica Mazza
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rocco Totaro
- Department of Neurology, San Salvatore Hospital, L’Aquila, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
- Department of Neurology, San Salvatore Hospital, L’Aquila, Italy
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Tian X, Hu R, He P, Ye J. Efficacy and safety of magnetic resonance-guided focused ultrasound for Parkinson's disease: a systematic review and meta-analysis. Front Neurol 2023; 14:1301240. [PMID: 38146437 PMCID: PMC10749343 DOI: 10.3389/fneur.2023.1301240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Objective Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is a novel noninvasive treatment for drug-resistant Parkinson's disease (PD) related tremor. This study aims to evaluate MRgFUS's efficacy and safety in PD through a systematic review and meta-analysis, examining pre-and post-treatment MDS-UPDRSIII and/or CRST scores and associated adverse events. Materials and methods We conducted an extensive literature search across PubMed, Embase, Web of Science, and Cochrane Library databases, screening studies based on set criteria and analyzing MDS-UPDRSIII, CRST, and adverse events pre- and post-MRgFUS treatment. Results Out of 468 retrieved articles, 20 studies involving 258 patients, spanning 2014-2023, were included.17 studies indicated significant MDS-UPDRSIII score reductions post-MRgFUS treatment, while 3 showed significant CRST score declines. In the "on" medication state, pooled MDS-UPDRSIII scores at 1, 3, 6, and 12 months were 12.18 (95% CI: 5.83-18.52), 12.10 (95% CI: 8.22-15.97), 14.85 (95% CI: 9.28-20.41), and 20.65 (95% CI: 12.15-29.14) respectively. In the "off" state, scores were 11.45 (95% CI: -3.50-26.40), 14.71 (95% CI: 4.95-24.46), 21.52 (95% CI: 19.28-23.75), and 22.28 (95% CI: 15.26-29.30). Adverse events were typically mild and transient, with speech disturbances, ataxia, and sensory abnormalities being common post-operative neurological complications. Conclusion MRgFUS offers an effective and relatively safe treatment option for patients with drug-resistant PD-related tremor. Systematic review registration https://www.crd.york.ac.uk/prospero/, No. CRD42023428332.
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Affiliation(s)
- Xiaona Tian
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Rongrui Hu
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Peicong He
- Eighth Clinical School, Guangzhou University of Chinese Medicine, Foshan, China
| | - Jianhong Ye
- Endocrinology Department, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
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Xu P, Wu N, Shen G. A rapid element pressure field simulation method for transcranial phase correction in focused ultrasound therapy. Phys Med Biol 2023; 68:235015. [PMID: 37934058 DOI: 10.1088/1361-6560/ad0a59] [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: 08/03/2023] [Accepted: 11/07/2023] [Indexed: 11/08/2023]
Abstract
Transcranial focused ultrasound ablation has emerged as a promising technique for treating neurological disorders. The clinical system exclusively employed the ray tracing method to compute phase aberrations induced by the human skull, taking into account computational time constraints. However, this method compromises slightly on accuracy compared to simulation-based methods. This study evaluates a fast simulation method that simulates the time-harmonic pressure field within the region of interest for effective phase correction. Experimental validation was carried out using a 512-element, 670 kHz hemispherical transducer for fourex vivoskulls. The ray tracing method achieved a restoration ratio of 64.81% ± 4.33% of acoustic intensity normalized to hydrophone measurements. In comparison, the rapid simulation method demonstrated improved results with a restoration ratio of 73.10% ± 7.46%, albeit slightly lower than the full-wave simulation which achieved a restoration ratio of 75.87% ± 5.40%. The rapid simulation methods exhibited computational times that were less than five minutes for parallel computation with 8 threads. The incident angle was calculated, and a maximum difference of 6.8 degrees was found when the fixed position of the skull was changed. Meanwhile, the restoration ratio of acoustic intensity was validated to be above 70% for different target positions away from the geometrical focus of the transducer. The favorable balance between time consumption and correction accuracy makes this method valuable for clinical treatment applications.
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Affiliation(s)
- Peng Xu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Nan Wu
- Shanghai Shende Green Medical Era Healthcare Technology Co., Ltd., Shanghai, People's Republic of China
| | - Guofeng Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Maragkos GA, Kosyakovsky J, Zhao P, Kearns KN, Rush-Evans S, Moosa S, Elias WJ. Patient-Reported Outcomes After Focused Ultrasound Thalamotomy for Tremor-Predominant Parkinson's Disease. Neurosurgery 2023; 93:884-891. [PMID: 37133259 DOI: 10.1227/neu.0000000000002518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) has emerged as a precise, incisionless approach to cerebral lesioning and an alternative to neuromodulation in movement disorders. Despite rigorous clinical trials, long-term patient-centered outcome data after MRgFUS for tremor-predominant Parkinson's Disease (TPPD) are relatively lacking. OBJECTIVE To report long-term data on patient satisfaction and quality of life after MRgFUS thalamotomy for TPPD. METHODS In a retrospective study of patients who underwent MRgFUS thalamotomy for TPPD at our institution between 2015 and 2022, a patient survey was administered to collect self-reported measures of tremor improvement, recurrence, Patients' Global Impression of Change (PGIC), and side effects. Patient demographics, FUS parameters, and lesion characteristics were analyzed. RESULTS A total of 29 patients were included with a median follow-up of 16 months. Immediate tremor improvement was achieved in 96% of patients. Sustained improvement was achieved in 63% of patients at last follow-up. Complete tremor recurrence to baseline occurred for 17% of patients. Life quality improvement denoted by a PGIC of 1 to 2 was reported by 69% of patients. Long-term side effects were reported by 38% of patients and were mostly mild. Performing a secondary anteromedial lesion to target the ventralis oralis anterior/posterior nucleus was associated with higher rates of speech-related side effects (56% vs 12%), without significant improvement in tremor outcomes. CONCLUSION Patient satisfaction with FUS thalamotomy for tremor-predominant PD was very high, even at longer term. Extended lesioning to target the motor thalamus did not improve tremor control and may contribute to greater frequency of postoperative motor- and speech-related side effects.
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Affiliation(s)
- Georgios A Maragkos
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Jacob Kosyakovsky
- University of Virginia School of Medicine, Charlottesville , Virginia , USA
| | - Patricia Zhao
- University of Virginia School of Medicine, Charlottesville , Virginia , USA
| | - Kathryn N Kearns
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Shelly Rush-Evans
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - Shayan Moosa
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
| | - W Jeffrey Elias
- Department of Neurosurgery, University of Virginia Health System, Charlottesville , Virginia , USA
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Zeng J, Chu H, Lu Y, Xiao X, Lu L, Li J, Lai G, Li L, Lu L, Xu N, Wang S. Research status and hotspots in the surgical treatment of tremor in Parkinson's disease from 2002 to 2022: a bibliometric and visualization analysis. Front Aging Neurosci 2023; 15:1157443. [PMID: 37829141 PMCID: PMC10565824 DOI: 10.3389/fnagi.2023.1157443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/06/2023] [Indexed: 10/14/2023] Open
Abstract
Objective This study aims to investigate the research status and hotspots of surgical treatment for tremor in Parkinson's disease (PD) from 2002 to 2022, utilizing bibliometric and visual analysis. Additionally, it aims to offer insights into future research trends in this field. Methods This study collected publications on the surgical treatment of tremor in PD from 2002 to 2022 using the Web of Science (WOS) database. CiteSpace, VOSviewer, and Scimago Graphica were employed to quantify the number of publications and analyze the bibliographic information networks, including the contributions of countries/cities, authors, keywords, and co-cited references. Results A total of 2,815 publications were included in the study, revealing that 541 scientific institutions experienced an increase in publications from 2002 to 2022. Michael Okun emerged as the most productive author, and the United States emerged as the leading hub for research. The study identified 772 keywords. Noteworthy citation bursts and long-term activity were observed in pallidotomy, bilateral stimulation, and focused ultrasound thalamotomy. The top 10 highly co-cited references comprised eight deep brain stimulation (DBS) studies (including two follow-up studies and six randomized controlled trials), one randomized controlled trial on focused ultrasound, and one consensus on tremor. Conclusion This study uses an in-depth and systematic bibliometric and visualization analysis to visualize the evolution of research and identify emerging hotspots. The identified hotspots are as follows: Firstly, DBS has received significant attention and widespread recognition as a surgical treatment for tremor in PD. Secondly, there are various key aspects to consider in DBS, such as operative indications, operative targets, and surgical protocols. Lastly, magnetic resonance-guided focused ultrasound (MRgFUS) has emerged as a promising treatment option in the surgical management of tremor in Parkinson's disease. This research also provides insights into the phenomenon of these hotspots, offering valuable prompts and reminders for further research.
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Affiliation(s)
- Jingchun Zeng
- Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui Chu
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiqian Lu
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xi Xiao
- Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liming Lu
- Clinical Research and Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jingjing Li
- Bao’an Traditional Chinese Medicine Hospital, Seventh Clinical Medical College of Guangzhou University of Traditional Chinese Medicine, Shenzhen, China
| | - Guoan Lai
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lisha Li
- Xingtan Hospital, The Affiliated Shunde Hospital of Southern Medical University, Foshan, China
| | - Lihong Lu
- Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Nenggui Xu
- Clinical Research and Data Center, South China Research Center for Acupuncture and Moxibustion, Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuxin Wang
- Rehabilitation Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Saporito G, Sucapane P, Ornello R, Cerone D, Bruno F, Splendiani A, Masciocchi C, Ricci A, Marini C, Sacco S, Pistoia F. Cognitive outcomes after focused ultrasound thalamotomy for tremor: Results from the COGNIFUS (COGNitive in Focused UltraSound) study. Parkinsonism Relat Disord 2023; 106:105230. [PMID: 36470172 DOI: 10.1016/j.parkreldis.2022.105230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is an innovative method for the unilateral treatment of essential tremor (ET) and Parkinson's disease (PD) related tremor. Our aim was to assess cognitive changes following MRgFUS thalamotomy to better investigate its safety profile. METHODS We prospectively investigated the cognitive and neurobehavioral profile of patients consecutively undergoing MRgFUS within a 2-year period. Patients had a comprehensive clinical and neuropsychological assessment before and six months after MRgFUS thalamotomy. RESULTS The final sample consisted of 40 patients (males 38; mean age±SD 67.7 ± 10.7; mean disease duration±SD 9.3 ± 5.6; ET 22, PD 18 patients). For the whole sample, improvements were detected in tremor (Fahn-Tolosa-Marin Clinical Rating Scale for tremor 35.79 ± 14.39 vs 23.03 ± 10.95; p < 0.001), anxiety feelings (Hamilton Anxiety rating scale 5.36 ± 3.80 vs 2.54 ± 3.28, p < 0.001), in the overall cognitive status (MMSE 25.93 ± 3.76 vs 27.54 ± 2.46, p 0.003; MOCA 22.80 ± 4.08 vs 24.48 ± 3.13, p < 0.001), and in quality of life (Quality of life in Essential Tremor Questionnaire 36.14 ± 12.91 vs 5.14 ± 6.90, p < 0.001 and PD Questionnaire-8 5.61 ± 4.65 vs 1.39 ± 2.33, p 0.001). No changes were detected in frontal and executive functions, verbal fluency and memory, abstract reasoning and problem-solving abilities. CONCLUSION Our study moves a step forward in establishing the cognitive sequelae of MRgFUS thalamotomy and in endorsing effectiveness and safety.
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Affiliation(s)
- Gennaro Saporito
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Davide Cerone
- Department of Neurology, San Salvatore Hospital, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, L'Aquila, Italy
| | - Carmine Marini
- Department of Neurology, San Salvatore Hospital, L'Aquila, Italy; Department of Internal Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy; Department of Neurology, San Salvatore Hospital, L'Aquila, Italy.
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Hu YY, Yang G, Liang XS, Ding XS, Xu DE, Li Z, Ma QH, Chen R, Sun YY. Transcranial low-intensity ultrasound stimulation for treating central nervous system disorders: A promising therapeutic application. Front Neurol 2023; 14:1117188. [PMID: 36970512 PMCID: PMC10030814 DOI: 10.3389/fneur.2023.1117188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/10/2023] [Indexed: 03/29/2023] Open
Abstract
Transcranial ultrasound stimulation is a neurostimulation technique that has gradually attracted the attention of researchers, especially as a potential therapy for neurological disorders, because of its high spatial resolution, its good penetration depth, and its non-invasiveness. Ultrasound can be categorized as high-intensity and low-intensity based on the intensity of its acoustic wave. High-intensity ultrasound can be used for thermal ablation by taking advantage of its high-energy characteristics. Low-intensity ultrasound, which produces low energy, can be used as a means to regulate the nervous system. The present review describes the current status of research on low-intensity transcranial ultrasound stimulation (LITUS) in the treatment of neurological disorders, such as epilepsy, essential tremor, depression, Parkinson's disease (PD), and Alzheimer's disease (AD). This review summarizes preclinical and clinical studies using LITUS to treat the aforementioned neurological disorders and discusses their underlying mechanisms.
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Affiliation(s)
- Yun-Yun Hu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
| | - Gang Yang
- Lab Center, Medical College of Soochow University, Suzhou, China
| | - Xue-Song Liang
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
- Second Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Xuan-Si Ding
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
| | - De-En Xu
- Wuxi No. 2 People's Hospital, Wuxi, Jiangsu, China
| | - Zhe Li
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Sleep Medicine Center, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Quan-Hong Ma
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
- Quan-Hong Ma
| | - Rui Chen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Rui Chen
| | - Yan-Yun Sun
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
- Yan-Yun Sun
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11
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Golfrè Andreasi N, Cilia R, Romito LM, Bonvegna S, Straccia G, Elia AE, Novelli A, Messina G, Tringali G, Levi V, Devigili G, Rinaldo S, Gasparini V, Grisoli M, Stanziano M, Ghielmetti F, Prioni S, Bocchi E, Amami P, Piacentini SHMJ, Ciceri EFM, Bruzzone MG, Eleopra R. Magnetic Resonance-Guided Focused Ultrasound Thalamotomy May Spare Dopaminergic Therapy in Early-Stage Tremor-Dominant Parkinson's Disease: A Pilot Study. Mov Disord 2022; 37:2289-2295. [PMID: 36036203 DOI: 10.1002/mds.29200] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/10/2022] [Accepted: 06/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is a safe and effective procedure for drug-resistant tremor in Parkinson's disease (PD). OBJECTIVE The aim of this study was to demonstrate that MRgFUS ventralis intermedius thalamotomy in early-stage tremor-dominant PD may prevent an increase in dopaminergic medication 6 months after treatment compared with matched PD control subjects on standard medical therapy. METHODS We prospectively enrolled patients with early-stage PD who underwent MRgFUS ventralis intermedius thalamotomy (PD-FUS) and patients treated with oral dopaminergic therapy (PD-ODT) with a 1:2 ratio. We collected demographic and clinical data at baseline and 6 and 12 months after thalamotomy. RESULTS We included 10 patients in the PD-FUS group and 20 patients in the PD-ODT group. We found a significant increase in total levodopa equivalent daily dose and levodopa plus monoamine oxidase B inhibitors dose in the PD-ODT group 6 months after thalamotomy. CONCLUSIONS In early-stage tremor-dominant PD, MRgFUS thalamotomy may be useful to reduce tremor and avoid the need to increase dopaminergic medications. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Nico Golfrè Andreasi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Roberto Cilia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Luigi Michele Romito
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Salvatore Bonvegna
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Giulia Straccia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Antonio Emanuele Elia
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Alessio Novelli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Giuseppe Messina
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurosurgery Department, Functional Neurosurgery Unit, Milan, Italy
| | - Giovanni Tringali
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurosurgery Department, Functional Neurosurgery Unit, Milan, Italy
| | - Vincenzo Levi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neurosurgery Department, Functional Neurosurgery Unit, Milan, Italy
| | - Grazia Devigili
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Sara Rinaldo
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Valentina Gasparini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
| | - Marina Grisoli
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milan, Italy
| | - Mario Stanziano
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milan, Italy.,Neuroscience Department "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Francesco Ghielmetti
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Health Department, Milan, Italy
| | - Sara Prioni
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Clinical Neuropsychology Unit, Milan, Italy
| | - Elisa Bocchi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Clinical Neuropsychology Unit, Milan, Italy
| | - Paolo Amami
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Clinical Neuropsychology Unit, Milan, Italy
| | | | - Elisa Francesca Maria Ciceri
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Diagnostic Radiology and Interventional Neuroradiology, Milan, Italy
| | - Maria Grazia Bruzzone
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Neuroradiology Unit, Milan, Italy
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Department of Clinical Neurosciences, Parkinson and Movement Disorders Unit, Milan, Italy
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12
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Bandopadhyay R, Mishra N, Rana R, Kaur G, Ghoneim MM, Alshehri S, Mustafa G, Ahmad J, Alhakamy NA, Mishra A. Molecular Mechanisms and Therapeutic Strategies for Levodopa-Induced Dyskinesia in Parkinson’s Disease: A Perspective Through Preclinical and Clinical Evidence. Front Pharmacol 2022; 13:805388. [PMID: 35462934 PMCID: PMC9021725 DOI: 10.3389/fphar.2022.805388] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/21/2022] [Indexed: 12/20/2022] Open
Abstract
Parkinson’s disease (PD) is the second leading neurodegenerative disease that is characterized by severe locomotor abnormalities. Levodopa (L-DOPA) treatment has been considered a mainstay for the management of PD; however, its prolonged treatment is often associated with abnormal involuntary movements and results in L-DOPA-induced dyskinesia (LID). Although LID is encountered after chronic administration of L-DOPA, the appearance of dyskinesia after weeks or months of the L-DOPA treatment has complicated our understanding of its pathogenesis. Pathophysiology of LID is mainly associated with alteration of direct and indirect pathways of the cortico-basal ganglia-thalamic loop, which regulates normal fine motor movements. Hypersensitivity of dopamine receptors has been involved in the development of LID; moreover, these symptoms are worsened by concurrent non-dopaminergic innervations including glutamatergic, serotonergic, and peptidergic neurotransmission. The present study is focused on discussing the recent updates in molecular mechanisms and therapeutic approaches for the effective management of LID in PD patients.
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Affiliation(s)
- Ritam Bandopadhyay
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Nainshi Mishra
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Ruhi Rana
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Gagandeep Kaur
- Department of Pharmacology, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
| | - Mohammed M. Ghoneim
- Department of Pharmacy Practice, College of Pharmacy, AlMaarefa University, Ad Diriyah, Saudi Arabia
| | - Sultan Alshehri
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Gulam Mustafa
- College of Pharmacy (Boys), Al-Dawadmi Campus, Shaqra University, Riyadh, Saudi Arabia
| | - Javed Ahmad
- Department of Pharmaceutics, College of Pharmacy, Najran University, Najran, Saudi Arabia
| | - Nabil. A. Alhakamy
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Awanish Mishra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)—Guwahati, Guwahati, India
- *Correspondence: Awanish Mishra, ,
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13
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Wang X, Xiong Y, Lin J, Lou X. Target Selection for Magnetic Resonance-Guided Focused Ultrasound in the Treatment of Parkinson's Disease. J Magn Reson Imaging 2022; 56:35-44. [PMID: 35081263 DOI: 10.1002/jmri.28080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 01/03/2023] Open
Abstract
Parkinson's disease (PD) is a common, progressive, and incurable neurodegenerative disease. Pharmacological treatment is the first-line therapy for PD, including carbidopa-levodopa, dopamine agonists. However, some patients respond poorly to medication. For these patients, functional neurosurgical treatment is an important option. Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel, minimally invasive surgical option for patients refractory to drugs. Currently, several important anatomical structures can be targeted by MRgFUS in the treatment of PD. However, there is no uniform standard for target selection. This review summarizes the clinical studies on MRgFUS for PD, focusing on the relationship between different treatment targets and the relieved symptoms, to help clinicians determine the ideal therapeutic target for individual patients. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Xiaoyu Wang
- Department of Radiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China.,School of Medicine, Nankai University, Tianjin, China
| | - Yongqin Xiong
- Department of Radiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Jiaji Lin
- Department of Radiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China
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14
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Titova NV, Katunina EA, Tairova RT, Sen'ko IV, Dzhafarov VM, Malykhina EA. [The problem of pharmacoresistant tremor in Parkinson's disease and essential tremor]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:24-30. [PMID: 36279225 DOI: 10.17116/jnevro202212210124] [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] [Indexed: 06/16/2023]
Abstract
MR-guided focused ultrasound (MRg-FUS) is a new noninvasive method for the treatment of contralateral disabling and pharmacoresistant tremor. Clinical studies have confirmed the high efficacy and safety of using MRg-FUS in patients with essential tremor and Parkinson's disease, in short and long-term studies. Advantages of this method in comparison with currently used invasive and noninvasive technics, potential brain target areas, the possibility of bilateral intervention, indications and contraindications are discussed.
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Affiliation(s)
- N V Titova
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Katunina
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - R T Tairova
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - I V Sen'ko
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - V M Dzhafarov
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
| | - E A Malykhina
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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15
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Cabrera LY, Young Han C, Ostendorf T, Jimenez-Shahed J, Sarva H. Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation. Neurol Clin Pract 2021; 11:506-516. [PMID: 34992957 PMCID: PMC8723941 DOI: 10.1212/cpj.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to explore current perspectives and attitudes of general neurologists and movement disorder specialists toward deep brain stimulation (DBS) for Parkinson disease (PD), focusing on perspectives on its earlier use in the clinical course of the disease. METHODS We designed a 30-question online survey comprised of Likert-type, multiple choice, and rank-order questions, which was distributed to 932 neurologist members of the American Academy of Neurology. We analyzed clinicians' sociodemographic information, treatment patterns used for patients with PD, reasons for and against patient referral for DBS, and general attitudes toward DBS. Data were analyzed using descriptive and inferential statistics. RESULTS We received 164/930 completed surveys (completion rate of 18%). Overall, most respondents agreed that DBS was more useful after the appearance of motor complications and that DBS utilization offered better management of PD than medication alone. However, respondents were divided on issues like minimum duration of disease needed to consider DBS as a treatment option and timing of DBS referral relative to disease progression. Specifically, differences between movement disorder specialists and general neurologists were seen in medication management of symptoms and dyskinesia. CONCLUSIONS There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS.
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Affiliation(s)
- Laura Yenisa Cabrera
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Catherine Young Han
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Tasha Ostendorf
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Joohi Jimenez-Shahed
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Harini Sarva
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
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16
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Kawabata K, Bagarinao E, Watanabe H, Maesawa S, Mori D, Hara K, Ohdake R, Masuda M, Ogura A, Kato T, Koyama S, Katsuno M, Wakabayashi T, Kuzuya M, Hoshiyama M, Isoda H, Naganawa S, Ozaki N, Sobue G. Bridging large-scale cortical networks: Integrative and function-specific hubs in the thalamus. iScience 2021; 24:103106. [PMID: 34622159 PMCID: PMC8479782 DOI: 10.1016/j.isci.2021.103106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 08/02/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022] Open
Abstract
The thalamus is critical for the brain's integrative hub functions; however, the localization and characterization of the different thalamic hubs remain unclear. Using a voxel-level network measure called functional connectivity overlap ratio (FCOR), we examined the thalamus' association with large-scale resting-state networks (RSNs) to elucidate its connector hub roles. Connections to the core-neurocognitive networks were localized in the anterior and medial parts, such as the anteroventral and mediodorsal nuclei areas. Regions functionally connected to the sensorimotor network were distinctively located around the lateral pulvinar nucleus but to a limited extent. Prominent connector hubs include the anteroventral, ventral lateral, and mediodorsal nuclei with functional connections to multiple RSNs. These findings suggest that the thalamus, with extensive connections to most of the RSNs, is well placed as a critical integrative functional hub and could play an important role for functional integration facilitating brain functions associated with primary processing and higher cognition. Multiple large-scale cortical networks converged in the thalamus Neurocognitive associated hub existed in the anterior and medial region Control-processing hub localized in the intermediate thalamus Sensorimotor network was located around the lateral pulvinar nucleus
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Affiliation(s)
- Kazuya Kawabata
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.,Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan
| | - Epifanio Bagarinao
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hirohisa Watanabe
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Department of Neurology, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Satoshi Maesawa
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Daisuke Mori
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan
| | - Kazuhiro Hara
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Reiko Ohdake
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Department of Neurology, Fujita Health University School of Medicine, Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan
| | - Michihito Masuda
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Aya Ogura
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshiyasu Kato
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shuji Koyama
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine and Institutes of Innovation for Future Society, Nagoya University, Nagoya, Aichi, Japan
| | - Minoru Hoshiyama
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Haruo Isoda
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Norio Ozaki
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Tsurumai-cho, Showa-ku, Nagoya, Aichi, Japan.,Aichi Medical University, Nagakute, Aichi, Japan
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17
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Pirooznia SK, Rosenthal LS, Dawson VL, Dawson TM. Parkinson Disease: Translating Insights from Molecular Mechanisms to Neuroprotection. Pharmacol Rev 2021; 73:33-97. [PMID: 34663684 DOI: 10.1124/pharmrev.120.000189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Parkinson disease (PD) used to be considered a nongenetic condition. However, the identification of several autosomal dominant and recessive mutations linked to monogenic PD has changed this view. Clinically manifest PD is then thought to occur through a complex interplay between genetic mutations, many of which have incomplete penetrance, and environmental factors, both neuroprotective and increasing susceptibility, which variably interact to reach a threshold over which PD becomes clinically manifested. Functional studies of PD gene products have identified many cellular and molecular pathways, providing crucial insights into the nature and causes of PD. PD originates from multiple causes and a range of pathogenic processes at play, ultimately culminating in nigral dopaminergic loss and motor dysfunction. An in-depth understanding of these complex and possibly convergent pathways will pave the way for therapeutic approaches to alleviate the disease symptoms and neuroprotective strategies to prevent disease manifestations. This review is aimed at providing a comprehensive understanding of advances made in PD research based on leveraging genetic insights into the pathogenesis of PD. It further discusses novel perspectives to facilitate identification of critical molecular pathways that are central to neurodegeneration that hold the potential to develop neuroprotective and/or neurorestorative therapeutic strategies for PD. SIGNIFICANCE STATEMENT: A comprehensive review of PD pathophysiology is provided on the complex interplay of genetic and environmental factors and biologic processes that contribute to PD pathogenesis. This knowledge identifies new targets that could be leveraged into disease-modifying therapies to prevent or slow neurodegeneration in PD.
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Affiliation(s)
- Sheila K Pirooznia
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Liana S Rosenthal
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Valina L Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
| | - Ted M Dawson
- Neuroregeneration and Stem Cell Programs, Institute for Cell Engineering (S.K.P., V.L.D., T.M.D.), Departments of Neurology (S.K.P., L.S.R., V.L.D., T.M.D.), Departments of Physiology (V.L.D.), Solomon H. Snyder Department of Neuroscience (V.L.D., T.M.D.), Department of Pharmacology and Molecular Sciences (T.M.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland; Adrienne Helis Malvin Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.); and Diana Helis Henry Medical Research Foundation, New Orleans, Louisiana (S.K.P., V.L.D., T.M.D.)
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18
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Lin J, Kang X, Xiong Y, Zhang D, Zong R, Yu X, Pan L, Lou X. Convergent structural network and gene signatures for MRgFUS thalamotomy in patients with Parkinson's disease. Neuroimage 2021; 243:118550. [PMID: 34481084 DOI: 10.1016/j.neuroimage.2021.118550] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/07/2021] [Accepted: 09/01/2021] [Indexed: 12/30/2022] Open
Abstract
MRgFUS has just been made available for the 1.7 million Parkinson's disease patients in China. Despite its non-invasive and rapid therapeutic advantages for involuntary tremor, some concerns have emerged about outcomes variability, non-specificity, and side-effects, as little is known about its impact on the long-term plasticity of brain structure. We sought to dissect the characteristics of long-term changes in brain structure caused by MRgFUS lesion and explored potential biological mechanisms. One-year multimodal imaging follow-ups were conducted for nine tremor-dominant Parkinson's disease patients undergoing unilateral MRgFUS thalamotomy. A structural connectivity map was generated for each patient to analyze dynamic changes in brain structure. The human brain transcriptome was extracted and spatially registered for connectivity vulnerability. Genetic functional enrichment analysis was performed and further clarified using in vivo emission computed tomography data. MRgFUS not only abolished tremors but also significantly disrupted the brain network topology. Network-based statistics identified a U-shape MRgFUS-sensitive subnetwork reflective of hand tremor recovery and surgical process, accompanied by relevant cerebral blood flow and gray matter alteration. Using human brain gene expression data, we observed that dopaminergic signatures were responsible for the preferential vulnerability associated with these architectural alterations. Additional PET/SPECT data not only validated these gene signatures, but also suggested that structural alteration was significantly correlated with D1 and D2 receptors, DAT, and F-DOPA measures. There was a long-term dynamic loop between structural alteration and dopaminergic signature for MRgFUS thalamotomy, which may be closely related to the long-term improvements in clinical tremor.
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Affiliation(s)
- Jiaji Lin
- Department of Radiology, Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
| | - Xiaopeng Kang
- School of Artificial Intelligence, University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100876, China; Brainnetome Center & National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Yongqin Xiong
- Department of Radiology, Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Dekang Zhang
- Department of Radiology, Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Rui Zong
- Department of Neurosurgery, Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Xinguang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China
| | - Longsheng Pan
- Department of Neurosurgery, Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, No.28 Fuxing Road, Beijing, 100853, China.
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19
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Clark A, Bonilla S, Suo D, Shapira Y, Averkiou M. Microbubble-Enhanced Heating: Exploring the Effect of Microbubble Concentration and Pressure Amplitude on High-Intensity Focused Ultrasound Treatments. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2296-2309. [PMID: 33985825 PMCID: PMC8243806 DOI: 10.1016/j.ultrasmedbio.2021.03.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 05/11/2023]
Abstract
High-intensity focused ultrasound (HIFU) is a non-invasive tool that can be used for targeted thermal ablation treatments. Currently, HIFU is clinically approved for treatment of uterine fibroids, various cancers, and certain brain applications. However, for brain applications such as essential tremors, HIFU can only be used to treat limited areas confined to the center of the brain because of geometrical limitations (shape of the transducer and skull). A major obstacle to advancing this technology is the inability to treat non-central brain locations without causing damage to the skin and/or skull. Previous research has indicated that cavitation-induced bubbles or microbubble contrast agents can be used to enhance HIFU treatments by increasing ablation regions and shortening acoustic exposures at lower acoustic pressures. However, little research has been done to explore the interplay between microbubble concentration and pressure amplitude on HIFU treatments. We developed an in vitro experimental setup to study lesion formation at three different acoustic pressures and three microbubble concentrations. Real-time ultrasound imaging was integrated to monitor initial microbubble concentration and subsequent behavior during the HIFU treatments. Depending on the pressure used for the HIFU treatment, there was an optimal concentration of microbubbles that led to enhanced heating in the focal area. If the concentration of microbubbles was too high, the treatment was detrimentally affected because of non-linear attenuation by the pre-focal microbubbles. Additionally, the real-time ultrasound imaging provided a reliable method to monitor microbubble activity during the HIFU treatments, which is important for translation to in vivo HIFU applications with microbubbles.
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Affiliation(s)
- Alicia Clark
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Sierra Bonilla
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Dingjie Suo
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | | | - Michalakis Averkiou
- Department of Bioengineering, University of Washington, Seattle, Washington, USA.
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20
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Ge Y, Wang Z, Gu F, Yang X, Chen Z, Dong W, Wang Z. Clinical application of magnetic resonance-guided focused ultrasound in Parkinson's disease: a meta-analysis of randomized clinical trials. Neurol Sci 2021; 42:3595-3604. [PMID: 34216307 DOI: 10.1007/s10072-021-05443-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the safety and efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) in the treatment of Parkinson's disease (PD). METHODS The databases of Medline, EMBASE, and the Cochrane Library were searched for eligible randomized controlled trials comparing focused ultrasound surgery (FUS) group vs. sham procedure group in PD. Weighted mean differences and standardized mean differences with corresponding 95% confidence intervals were used to summarize the primary outcome, namely, the effect of MRgFUS to improve limb tremor in PD patients and adverse events, and the secondary outcome, which is the effect of MRgFUS in improving the quality of life, activities of daily living, and non-motor symptoms. RESULTS The pooled analysis comprised 2 studies. The blinded phase lasted for 4 months in one experiment and up to 3 months in the other. The FUS group showed significant improvement in limb tremor on the treated side (SMD: - 1.20; 95% CI: - 2.06, - 0.34) and the ability to perform daily activities (SMD: - 0.86; 95% CI: - 1.41, - 0.32) compared to the sham group, but there were no significant group differences in other indicators. Of the process-related adverse events, dizziness (OR: 4.68; 95% CI: 1.20, 18.23) was more common in the treatment group, with no group differences in the remaining adverse events. CONCLUSIONS These findings suggest beneficial effects of MRgFUS in PD patients with no serious side effects. Larger multicenter studies are needed in the future to select the most appropriate target and surgical device setup parameters.
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Affiliation(s)
- Yi Ge
- Department of Neurology, The First Affiliated Hospital of Soochow University, Jiangsu Province, 188 Shizi Street, Suzhou, 215006, China
| | - Zilan Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, 188 Shizi Street, Suzhou, 215006, China
| | - Feng Gu
- First Clinical Medical School, Soochow University, Suzhou, 215006, Jiangsu Province, China
| | - Xingyu Yang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, 188 Shizi Street, Suzhou, 215006, China
| | - Zhouqing Chen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, 188 Shizi Street, Suzhou, 215006, China
| | - Wanli Dong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Jiangsu Province, 188 Shizi Street, Suzhou, 215006, China.
- Department of Neurology, Dushuhu Public Hospital Affiliated To Soochow University, Jiangsu Province, Suzhou, 215006, China.
| | - Zhong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Jiangsu Province, 188 Shizi Street, Suzhou, 215006, China
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21
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Doshi PK. Radiofrequency Lesioning for Movement and Psychiatric Disorders-Experience of 107 Cases. Front Hum Neurosci 2021; 15:673848. [PMID: 34194307 PMCID: PMC8236715 DOI: 10.3389/fnhum.2021.673848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022] Open
Abstract
Background Radiofrequency lesioning (RFL) though used since the 1950s, had been replaced by DBS in the 1990s. The availability of magnetic resonance-guided focused ultrasound for lesioning has renewed the interest in RFL. Objective This paper analysis RFL in contemporary Functional Neurosurgery for various indications and its outcome. Complication rates of RFL are compared with the same author’s experience of DBS. Methods One hundred and seven patients underwent RFL between 1998 and 2019. Indications included Parkinson’s Disease (PD), tremors, dystonia, and obsessive-compulsive disorders (OCD). The surgeries performed include thalamotomy (29), pallidotomy (49), subthalamotomy (23), and anterior capsulotomy/nucleus accumbens lesioning (6). Appropriate rating scales were used for preoperative and postoperative evaluations. Results There was a 25% recurrence rate of tremors for PD after thalamotomy. Writer’s cramp rating scale improved from a mean of 10.54–1.6 in task specific dystonia (TSD) patients, after thalamotomy. In PD patients, after pallidotomy, contralateral motor Unified Parkinson’s Disease Rating Scale (UPDRS) and dyskinesia scores, improved by 41 and 57%, respectively, at 1-year. Burke-Fahn-Marsden Dystonia Rating Scale in hemidystonia patients improved from 18.04 to 6.91, at 1-year. There was 32 and 31% improvement in total and motor UPDRS, respectively, in the subthalamotomy patients, at 2-year. All patients of OCD were in remission. There were three deaths in the pallidotomy group. Postoperative, dysarthria, confusion, hemiparesis, dyskinesia, and paraesthesia occurred in 12 patients, of which, 7 were transient. Conclusion RFL is a useful option in a select group of patients with tremors and dystonia. It is our preferred treatment option for TSD and OCD.
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22
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Martínez-Fernández R, Matarazzo M, Máñez-Miró JU, Obeso JA. The Role of Focused Ultrasound in the Management of Movement Disorders: Insights after 5 Years of Experience. Mov Disord Clin Pract 2021; 8:681-687. [PMID: 34307739 DOI: 10.1002/mdc3.13223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/26/2021] [Accepted: 04/07/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Raúl Martínez-Fernández
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) Hospital Universitario HM Puerta del Sur, HM Hospitales Madrid Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases Carlos III Institute Madrid Spain
| | - Michele Matarazzo
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) Hospital Universitario HM Puerta del Sur, HM Hospitales Madrid Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases Carlos III Institute Madrid Spain
| | - Jorge U Máñez-Miró
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) Hospital Universitario HM Puerta del Sur, HM Hospitales Madrid Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases Carlos III Institute Madrid Spain
| | - Jose A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal) Hospital Universitario HM Puerta del Sur, HM Hospitales Madrid Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases Carlos III Institute Madrid Spain
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23
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Custom, spray coated receive coils for magnetic resonance imaging. Sci Rep 2021; 11:2635. [PMID: 33514816 PMCID: PMC7846777 DOI: 10.1038/s41598-021-81833-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022] Open
Abstract
We have developed a process for fabricating patient specific Magnetic Resonance Imaging (MRI) Radio-frequency (RF) receive coil arrays using additive manufacturing. Our process involves spray deposition of silver nanoparticle inks and dielectric materials onto 3D printed substrates to form high-quality resonant circuits. In this paper, we describe the material selection and characterization, process optimization, and design and testing of a prototype 4-channel neck array for carotid imaging. We show that sprayed polystyrene can form a low loss dielectric layer in a parallel plate capacitor. We also demonstrate that by using sprayed silver nanoparticle ink as conductive traces, our devices are still dominated by sample noise, rather than material losses. These results are critical for maintaining high Signal-to-Noise-Ratio (SNR) in clinical settings. Finally, our prototype patient specific coil array exhibits higher SNR (5 × in the periphery, 1.4 × in the center) than a commercially available array designed to fit the majority of subjects when tested on our custom neck phantom. 3D printed substrates ensure an optimum fit to complex body parts, improve diagnostic image quality, and enable reproducible placement on subjects.
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24
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Sharma VD, Patel M, Miocinovic S. Surgical Treatment of Parkinson's Disease: Devices and Lesion Approaches. Neurotherapeutics 2020; 17:1525-1538. [PMID: 33118132 PMCID: PMC7851282 DOI: 10.1007/s13311-020-00939-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2020] [Indexed: 10/23/2022] Open
Abstract
Surgical treatments have transformed the management of Parkinson's disease (PD). Therapeutic options available for the management of PD motor complications include deep brain stimulation (DBS), ablative or lesioning procedures (pallidotomy, thalamotomy, subthalamotomy), and dopaminergic medication infusion devices. The decision to pursue these advanced treatment options is typically done by a multidisciplinary team by considering factors such as the patient's clinical characteristics, efficacy, ease of use, and risks of therapy with a goal to improve PD symptoms and quality of life. DBS has become the most widely used surgical therapy, although there is a re-emergence of interest in ablative procedures with the introduction of MR-guided focused ultrasound. In this article, we review DBS and lesioning procedures for PD, including indications, selection process, and management strategies.
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Affiliation(s)
- Vibhash D Sharma
- Department of Neurology, University of Kansas Medical Center, 3599 Rainbow Blvd, MS 3042, Kansas City, KS, 66160, USA.
| | - Margi Patel
- Department of Neurology, Emory University, Atlanta, GA, USA
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25
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Fiani B, Lissak IA, Soula M, Sarhadi K, Shaikh ES, Baig A, Farooqui M, Quadri SA. The Emerging Role of Magnetic Resonance Imaging-Guided Focused Ultrasound in Functional Neurosurgery. Cureus 2020; 12:e9820. [PMID: 32953330 PMCID: PMC7496034 DOI: 10.7759/cureus.9820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Functional disorders of the central nervous system (CNS) are diverse in terms of their etiology and symptoms, however, they can be quite debilitating. Many functional neurological disorders can progress to a level where pharmaceuticals and other early lines of treatment can no longer optimally treat the condition, therefore requiring surgical intervention. A variety of stereotactic and functional neurosurgical approaches exist, including deep brain stimulation, implantation, stereotaxic lesions, and radiosurgery, among others. Most techniques are invasive or minimally invasive forms of surgical intervention and require immense precision to effectively modulate CNS circuitry. Focused ultrasound (FUS) is a relatively new, safe, non-invasive neurosurgical approach that has demonstrated efficacy in treating a range of functional neurological diseases. It can function reversibly, through mechanical stimulation causing circuitry changes, or irreversibly, through thermal ablation at low and high frequencies respectively. In preliminary studies, magnetic resonance imaging-guided high-intensity focused ultrasound (MRgHIFU) has been shown to have long-lasting treatment effects in several disease types. The technology has been approved by the FDA and internationally for a number of treatment-resistant neurological disorders and currently clinical trials are underway for several other neurological conditions. In this review, the authors discuss the potential applications and emerging role of MRgHIFU in functional neurosurgery in the coming years.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - India A Lissak
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | | | | | - Emad Salman Shaikh
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Aqsa Baig
- Neurology, Liaquat National Hospital and Medical College, Karachi, PAK
| | | | - Syed A Quadri
- Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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26
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Oishi K, Mori S, Troncoso JC, Lenz FA. Mapping tracts in the human subthalamic area by 11.7T ex vivo diffusion tensor imaging. Brain Struct Funct 2020; 225:1293-1312. [PMID: 32303844 DOI: 10.1007/s00429-020-02066-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
The cortico-basal ganglia-thalamo-cortical feedback loops that consist of distinct white matter pathways are important for understanding in vivo imaging studies of functional and anatomical connectivity, and for localizing subthalamic white matter structures in surgical approaches for movement disorders, such as Parkinson's disease. Connectomic analysis in animals has identified fiber connections between the basal ganglia and thalamus, which pass through the fields of Forel, where other fiber pathways related to motor, sensory, and cognitive functions co-exist. We now report these pathways in the human brain on ex vivo mesoscopic (250 μm) diffusion tensor imaging and on tractography. The locations of the tracts were identified relative to the adjacent gray matter structures, such as the internal and external segments of the globus pallidus; the zona incerta; the subthalamic nucleus; the substantia nigra pars reticulata and compacta; and the thalamus. The connectome atlas of the human subthalamic region may serve as a resource for imaging studies and for neurosurgical planning.
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Affiliation(s)
- Kenichi Oishi
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 208 Traylor Building, 720 Rutland Ave., Baltimore, MD, 21205, USA.
| | - Susumu Mori
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 208 Traylor Building, 720 Rutland Ave., Baltimore, MD, 21205, USA.,Kennedy Krieger Institute, Baltimore, MD, USA
| | - Juan C Troncoso
- Division of Neuropathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frederick A Lenz
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Meyer 8181 Neurosurgery, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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27
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Xu Y, He Q, Wang W. Comment on "The role of high-intensity focused ultrasound as a symptomatic treatment for Parkinson's disease". Mov Disord 2020; 35:521. [PMID: 32166803 DOI: 10.1002/mds.27977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Yangyang Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Qi He
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
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28
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Gallay MN, Moser D, Rossi F, Magara AE, Strasser M, Bühler R, Kowalski M, Pourtehrani P, Dragalina C, Federau C, Jeanmonod D. MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience. Front Surg 2020; 6:76. [PMID: 31993437 PMCID: PMC6971056 DOI: 10.3389/fsurg.2019.00076] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
Background: There is a long history, beginning in the 1940s, of ablative neurosurgery on the pallidal efferent fibers to treat patients suffering from Parkinson's disease (PD). Since the early 1990s, we undertook a re-actualization of the approach to the subthalamic region, and proposed, on a histological basis, to target specifically the pallidothalamic tract at the level of Forel's field H1. This intervention, the pallidothalamic tractotomy (PTT), has been performed since 2011 using the MR-guided focused ultrasound (MRgFUS) technique. A reappraisal of the histology of the pallidothalamic tract was combined recently with an optimization of our lesioning strategy using thermal dose control. Objective: This study was aimed at demonstrating the efficacy and risk profile of MRgFUS PTT against chronic therapy-resistant PD. Methods: This consecutive case series reflects our current treatment routine and was collected between 2017 and 2018. Fifty-two interventions in 47 patients were included. Fifteen patients received bilateral PTT. The median follow-up was 12 months. Results: The Unified Parkinson's Disease Rating Scale (UPDRS) off-medication postoperative score was compared to the baseline on-medication score and revealed percentage reductions of the mean of 84% for tremor, 70% for rigidity, and 73% for distal hypobradykinesia, all values given for the treated side. Axial items (for voice, trunk and gait) were not significantly improved. PTT achieved 100% suppression of on-medication dyskinesias as well as reduction in pain (p < 0.001), dystonia (p < 0.001) and REM sleep disorders (p < 0.01). Reduction of the mean L-Dopa intake was 55%. Patients reported an 88% mean tremor relief and 82% mean global symptom relief on the operated side and 69% mean global symptom improvement for the whole body. There was no significant change of cognitive functions. The small group of bilateral PTTs at 1 year follow-up shows similar results as compared to unilateral PTTs but does not allow to draw firm conclusions at this point. Conclusion: MRgFUS PTT was shown to be a safe and effective intervention for PD patients, addressing all symptoms, with varying effectiveness. We discuss the need to integrate the preoperative state of the thalamocortical network as well as the psycho-emotional dimension.
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Affiliation(s)
- Marc N Gallay
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland
| | - David Moser
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland
| | - Franziska Rossi
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland
| | | | - Maja Strasser
- Neurologische Praxis Solothurn, Solothurn, Switzerland
| | - Robert Bühler
- Neurological Division, Bürgerspital Solothurn, Solothurn, Switzerland
| | | | | | | | - Christian Federau
- Department of Radiology, University Hospital Basel, Basel, Switzerland.,Institute for Biomedical Engineering, ETH Zürich, University Zürich, Zurich, Switzerland
| | - Daniel Jeanmonod
- SoniModul, Center for Ultrasound Functional Neurosurgery, Solothurn, Switzerland
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29
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Xu Y, He Q, Wang M, Gao Y, Liu X, Li D, Xiong B, Wang W. Safety and efficacy of magnetic resonance imaging-guided focused ultrasound neurosurgery for Parkinson's disease: a systematic review. Neurosurg Rev 2019; 44:115-127. [PMID: 31814058 DOI: 10.1007/s10143-019-01216-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/06/2019] [Accepted: 11/20/2019] [Indexed: 02/05/2023]
Abstract
Magnetic resonance imaging-guided focused ultrasound (MRgFUS) neurosurgery is a new option for medication-resistant Parkinson's disease (PD), but its safety and efficacy remain elusive. This study aimed to investigate the safety and efficacy of MRgFUS for PD by systematically reviewing related literature. PubMed and EMBASE were searched to identify related studies. Inclusion criteria were (1) reported the efficacy or safety of MRgFUS for PD and (2) published in English. Exclusion criteria were (1) nonhuman study, (2) review or meta-analysis or other literature types without original data, and (3) conference abstract without full text. Data on study characteristics, treatment parameters, efficacy, and adverse events were collected. Descriptive synthesis of data was performed. Eleven studies containing 80 patients were included. Nine studies were observational studies with no controls. Two studies included a randomized and controlled phase. Most studies included tremor-dominant PD. Ten studies reported decline of UPDRS-III scores after MRgFUS, and five reported a statistically significant decline. Nine studies evaluated the quality of life (QOL). Significant improvement of QOL was reported by four studies using the 39-item Parkinson's disease questionnaire. Four studies investigated the impact of MRgFUS on non-motor symptoms. Most tests indicated that MRgFUS had no significant effect on neuropsychological outcomes. Most adverse events were mild and transient. MRgFUS is a potential treatment for PD with satisfying efficacy and safety. Studies in this field are still limited. More studies with strict design, larger sample size, and longer follow-up are needed to further investigate its efficacy and safety for PD.
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Affiliation(s)
- Yangyang Xu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Qi He
- Department of Neonatology, West China Second University Hospital Sichuan University, Chengdu, 610041, China
| | - Mengqi Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yuan Gao
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Xiaowei Liu
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Denghui Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Botao Xiong
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, 610041, China.
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30
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Gallay MN, Moser D, Federau C, Jeanmonod D. Anatomical and Technical Reappraisal of the Pallidothalamic Tractotomy With the Incisionless Transcranial MR-Guided Focused Ultrasound. A Technical Note. Front Surg 2019; 6:2. [PMID: 30733946 PMCID: PMC6353787 DOI: 10.3389/fsurg.2019.00002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
Background: MR-guided focused ultrasound (MRgFUS) offers new perspectives for safe and efficient lesioning inside the brain. The issue of target coverage remains primordial and sub-optimally addressed or solved in the field of functional neurosurgery. Objective: To provide an optimized planning and operative strategy to perform a pallidothalamic tractotomy (PTT) in chronic therapy-resistant Parkinson's disease (PD) with the technology of MRgFUS. Methods and results: Histological sections and maps from 6 human brain hemispheres were analyzed and outlines of the pallidothalamic tract on Myelin-stained sections were drawn and superimposed. We determined a standardized PTT target coverage characterized by 5 to 7 preplanned target lesion sub-units of 1.5 × 1.5 × 3.0 mm, which were placed using focal point displacements and shortest possible times, under thermal dose control. Conclusion: We hereby present our current approach to the MRgFUS PTT on the basis of a histological reappraisal and optimized heat application to the pallidothalamic tract in the H1 field of Forel.
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Affiliation(s)
- Marc N. Gallay
- Center for Ultrasound Functional Neurosurgery, SoniModul, Solothurn, Switzerland
| | - David Moser
- Center for Ultrasound Functional Neurosurgery, SoniModul, Solothurn, Switzerland
| | - Christian Federau
- Institute for Biomedical Engineering, ETH Zürich, University of Zürich, Zurich, Switzerland
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Daniel Jeanmonod
- Center for Ultrasound Functional Neurosurgery, SoniModul, Solothurn, Switzerland
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31
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Lee EJ, Fomenko A, Lozano AM. Magnetic Resonance-Guided Focused Ultrasound : Current Status and Future Perspectives in Thermal Ablation and Blood-Brain Barrier Opening. J Korean Neurosurg Soc 2018; 62:10-26. [PMID: 30630292 PMCID: PMC6328789 DOI: 10.3340/jkns.2018.0180] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/13/2018] [Indexed: 02/06/2023] Open
Abstract
Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging new technology with considerable potential to treat various neurological diseases. With refinement of ultrasound transducer technology and integration with magnetic resonance imaging guidance, transcranial sonication of precise cerebral targets has become a therapeutic option. Intensity is a key determinant of ultrasound effects. High-intensity focused ultrasound can produce targeted lesions via thermal ablation of tissue. MRgFUS-mediated stereotactic ablation is non-invasive, incision-free, and confers immediate therapeutic effects. Since the US Food and Drug Administration approval of MRgFUS in 2016 for unilateral thalamotomy in medication-refractory essential tremor, studies on novel indications such as Parkinson's disease, psychiatric disease, and brain tumors are underway. MRgFUS is also used in the context of blood-brain barrier (BBB) opening at low intensities, in combination with intravenously-administered microbubbles. Preclinical studies show that MRgFUS-mediated BBB opening safely enhances the delivery of targeted chemotherapeutic agents to the brain and improves tumor control as well as survival. In addition, BBB opening has been shown to activate the innate immune system in animal models of Alzheimer's disease. Amyloid plaque clearance and promotion of neurogenesis in these studies suggest that MRgFUS-mediated BBB opening may be a new paradigm for neurodegenerative disease treatment in the future. Here, we review the current status of preclinical and clinical trials of MRgFUS-mediated thermal ablation and BBB opening, described their mechanisms of action, and discuss future prospects.
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Affiliation(s)
- Eun Jung Lee
- Toronto Western Research Institute, University Health Network, Toronto, Canada
| | - Anton Fomenko
- Toronto Western Research Institute, University Health Network, Toronto, Canada
| | - Andres M Lozano
- Toronto Western Research Institute, University Health Network, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Canada
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Del Rey NLG, Quiroga-Varela A, Garbayo E, Carballo-Carbajal I, Fernández-Santiago R, Monje MHG, Trigo-Damas I, Blanco-Prieto MJ, Blesa J. Advances in Parkinson's Disease: 200 Years Later. Front Neuroanat 2018; 12:113. [PMID: 30618654 PMCID: PMC6306622 DOI: 10.3389/fnana.2018.00113] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022] Open
Abstract
When James Parkinson described the classical symptoms of the disease he could hardly foresee the evolution of our understanding over the next two hundred years. Nowadays, Parkinson’s disease is considered a complex multifactorial disease in which genetic factors, either causative or susceptibility variants, unknown environmental cues, and the potential interaction of both could ultimately trigger the pathology. Noteworthy advances have been made in different fields from the clinical phenotype to the decoding of some potential neuropathological features, among which are the fields of genetics, drug discovery or biomaterials for drug delivery, which, though recent in origin, have evolved swiftly to become the basis of research into the disease today. In this review, we highlight some of the key advances in the field over the past two centuries and discuss the current challenges focusing on exciting new research developments likely to come in the next few years. Also, the importance of pre-motor symptoms and early diagnosis in the search for more effective therapeutic options is discussed.
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Affiliation(s)
- Natalia López-González Del Rey
- HM CINAC, Hospital Universitario HM Puerta del Sur, Madrid, Spain.,Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Ana Quiroga-Varela
- Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Department of Neuroscience, Centro de Investigación Médica Aplicada (CIMA), University of Navarra, Pamplona, Spain
| | - Elisa Garbayo
- Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Iria Carballo-Carbajal
- Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Neurodegenerative Diseases Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rubén Fernández-Santiago
- Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain.,Laboratory of Parkinson Disease and other Neurodegenerative Movement Disorders, Department of Neurology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Mariana H G Monje
- HM CINAC, Hospital Universitario HM Puerta del Sur, Madrid, Spain.,Department of Anatomy, Histology and Neuroscience, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Inés Trigo-Damas
- HM CINAC, Hospital Universitario HM Puerta del Sur, Madrid, Spain.,Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - María J Blanco-Prieto
- Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Javier Blesa
- HM CINAC, Hospital Universitario HM Puerta del Sur, Madrid, Spain.,Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), Madrid, Spain
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The Role of the Anesthesiologist during Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Tremor: A Single-Center Experience. PARKINSONS DISEASE 2018; 2018:9764807. [PMID: 30123491 PMCID: PMC6079322 DOI: 10.1155/2018/9764807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/24/2018] [Accepted: 06/06/2018] [Indexed: 01/30/2023]
Abstract
Ablative incisionless neurosurgery has become possible through advances in focused ultrasound and magnetic resonance imaging (MRI). The great advantage of MRI-guided focused ultrasound (MRgFUS) is that the ablation is performed through an intact skull without surgery. Here, we review the new modality of MRgFUS for treating tremor and enlighten the role of the anesthesiologist in the unique procedural setting of the MRI suite. During the MRgFUS process, the patients should be awake and are required to cooperate with the medical staff to allow assessment of tremor reduction and potential occurrence of adverse effects. In addition, the patient's head is immobilized inside the MRI tunnel for hours. This combination presents major challenges for the attending anesthesiologist, who is required to try to prevent pain and nausea and when present, to treat these symptoms. Anxiety, vertigo, and vomiting may occur during treatment and require urgent treatment. Here, we review the literature available on anesthetic management during the procedure and our own experience and provide recommendations based on our collected knowledge.
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Bretsztajn L, Gedroyc W. Brain-focussed ultrasound: what's the "FUS" all about? A review of current and emerging neurological applications. Br J Radiol 2018; 91:20170481. [PMID: 29419328 PMCID: PMC6221771 DOI: 10.1259/bjr.20170481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 01/12/2018] [Accepted: 02/01/2018] [Indexed: 11/05/2022] Open
Abstract
MR-guided focussed ultrasound surgery (MRgFUS) allows for precise non-invasive thermal ablation of target tissues for a wide range of clinical applications. It is an innovative and rapidly expanding technology, which has already established itself as an effective and safe incisionless alternative in the treatment of various soft tissue tumours, with many more research studies underway to extend its therapeutic envelope. The non-invasiveness of the procedure makes FUS particularly attractive in functional neurosurgery, where existing treatment options are not suitable for all patients. Several clinical trials have demonstrated the feasibility and favourable safety profile of MR-guided focused ultrasound surgery in essential tremor, Parkinson's disease and other neurological conditions. This article reviews the existing evidence base for the neurological applications of FUS and the evidence for its emerging roles in the treatment of a range of brain disorders.
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Affiliation(s)
- Laure Bretsztajn
- Radiology Department, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Wladyslaw Gedroyc
- Radiology Department, Imperial College Healthcare NHS Trust, London, United Kingdom
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35
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Efficient Blood-Brain Barrier Opening in Primates with Neuronavigation-Guided Ultrasound and Real-Time Acoustic Mapping. Sci Rep 2018; 8:7978. [PMID: 29789530 PMCID: PMC5964111 DOI: 10.1038/s41598-018-25904-9] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 05/01/2018] [Indexed: 11/30/2022] Open
Abstract
Brain diseases including neurological disorders and tumors remain under treated due to the challenge to access the brain, and blood-brain barrier (BBB) restricting drug delivery which, also profoundly limits the development of pharmacological treatment. Focused ultrasound (FUS) with microbubbles is the sole method to open the BBB noninvasively, locally, and transiently and facilitate drug delivery, while translation to the clinic is challenging due to long procedure, targeting limitations, or invasiveness of current systems. In order to provide rapid, flexible yet precise applications, we have designed a noninvasive FUS and monitoring system with the protocol tested in monkeys (from in silico preplanning and simulation, real-time targeting and acoustic mapping, to post-treatment assessment). With a short procedure (30 min) similar to current clinical imaging duration or radiation therapy, the achieved targeting (both cerebral cortex and subcortical structures) and monitoring accuracy was close to the predicted 2-mm lower limit. This system would enable rapid clinical transcranial FUS applications outside of the MRI system without a stereotactic frame, thereby benefiting patients especially in the elderly population.
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36
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Ito H, Fukutake S, Yamamoto K, Yamaguchi T, Taira T, Kamei T. Magnetic Resonance Imaging-guided Focused Ultrasound Thalamotomy for Parkinson's Disease. Intern Med 2018; 57:1027-1031. [PMID: 29269662 PMCID: PMC5919866 DOI: 10.2169/internalmedicine.9586-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Thalamotomy is effective in treating refractory tremor in Parkinson's disease (PD). We herein report a PD patient who underwent left ventral intermediate nucleus and ventro oralis posterior nucleus thalamotomy using magnetic resonance imaging-guided focused ultrasound (MRgFUS). Right-side resting tremor and rigidity were abolished immediately following the ultrasound energy delivery. In addition, left-side resting tremor and rigidity also improved. No adverse events occurred during the procedure. We observed the exacerbation of bradykinesia, which might have been caused by edema around the target. This is the first report of thalamotomy using MRgFUS for PD patient from Japan. Further investigations concerning the efficacy and safety of this procedure are necessary.
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Affiliation(s)
- Hisashi Ito
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
| | - Shigeru Fukutake
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
| | - Kazuaki Yamamoto
- Department of Neurosurgery, Shonan Kamakura General Hospital, Japan
| | - Toshio Yamaguchi
- Research Institute of Diagnostic Imaging, Shin-Yurigaoka General Hospital, Japan
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University, Japan
| | - Tetsumasa Kamei
- Department of Neurology, Shonan Fujisawa Tokushukai Hospital, Japan
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37
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Abstract
BACKGROUND The development of high-intensity magnetic resonance imaging (MRI)-guided focused ultrasound (MRIgFUS) ablation has widened the spectrum of interventional techniques for stereotactic functional neurosurgery of lesions. This has resulted in novel incisionless intervention approaches for the therapy of tremor disorders. The safety and efficacy is documented by recent study data. OBJECTIVES This article encompasses a description of the technological basis and typical course of MRIgFUS interventions, a comparison to alternative open or incisionless surgical techniques as well as a review of the current evidence base for MRIgFUS ablation in the context of lesional interventions to treat tremor. MATERIAL AND METHODS Narrative literature review and comparison. RESULTS Depending on the surgical target and tremor etiology published trials of MRIgFUS ablation report a reduction of tremor intensity of up to 80% after 6-12 months follow-up without the disadvantages of open brain surgery. CONCLUSION The MRIgFUS functional neurosurgery is conducted only at a limited number of treatment sites. First data on lesions of the thalamic ventral intermediary nucleus (V.im.) as well as subthalamic fiber tracts have been published. These results indicate an effective and safe treatment of tremor disorders by MRIgFUS ablation. Incisionless lesional surgery using MRIgFUS is a significant addition to the interventional armamentarium for functional stereotactic neurosurgery and a potentially valuable alternative to established interventional therapy options for tremor disorders.
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38
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Meng Y, Suppiah S, Mithani K, Solomon B, Schwartz ML, Lipsman N. Current and emerging brain applications of MR-guided focused ultrasound. J Ther Ultrasound 2017; 5:26. [PMID: 29034095 PMCID: PMC5629772 DOI: 10.1186/s40349-017-0105-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/28/2017] [Indexed: 12/30/2022] Open
Abstract
MRI guided focused ultrasound is an emerging technique that uses acoustic energy to noninvasively treat intracranial disorders. At high frequencies, it can be used to raise tissue temperatures and ablate discrete brain targets with sub-millimeter accuracy. This application is currently under investigation for a broad range of clinical applications, including brain tumors, movement disorders, and psychiatric conditions. At low frequencies MRI guided focused ultrasound can be used to modulate neuronal activity and in conjunction with injected microbubbles, can open the blood-brain barrier to enhance the delivery of therapeutic compounds. The last decade has seen dramatic advances in the science of MRI guided focused ultrasound, helping elucidate both its mechanisms and potential in pre-clinical models, and its translational promise across myriad clinical applications. This review provides an update of current and emerging MRI guided focused ultrasound applications for intracranial disorders and describes future directions and challenges for the field.
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Affiliation(s)
- Ying Meng
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON Canada
| | - Suganth Suppiah
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON Canada
| | - Karim Mithani
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON Canada
| | - Benjamin Solomon
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON Canada
| | - Michael L Schwartz
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON Canada
| | - Nir Lipsman
- Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON Canada
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Raju SS, Niranjan A, Monaco III EA, Flickinger JC, Lunsford LD. Stereotactic Radiosurgery for Intractable Tremor-Dominant Parkinson Disease: A Retrospective Analysis. Stereotact Funct Neurosurg 2017; 95:291-297. [DOI: 10.1159/000479236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/06/2017] [Indexed: 11/19/2022]
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40
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Fishman PS. Thalamotomy for essential tremor: FDA approval brings brain treatment with FUS to the clinic. J Ther Ultrasound 2017; 5:19. [PMID: 28717511 PMCID: PMC5508673 DOI: 10.1186/s40349-017-0096-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 04/14/2017] [Indexed: 12/05/2022] Open
Affiliation(s)
- Paul S Fishman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201 USA
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41
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Abstract
The discovery that ultrasound waves could be focused inside the skull and heated to high temperatures at a focal point goes back to 1944. However, because the skull causes the ultrasound waves to attenuate and scatter, it was believed that application of this technology would be difficult, and that it would be impossible to use this approach in the surgical treatment of intracranial diseases. Eventually, magnetic resonance image guided focused ultrasound (MRgFUS) surgery began being used to treat uterine fibroids, breast cancer and bone metastasis and locally confined prostate cancer. In the first ten years of the 21st century, new developments in this technology have been achieved, broadening the scope of practical application, and treatment is now being performed in various countries around the world. In 2011, third-generation transcranial focused ultrasound made it possible to use thermocoagulation and create intracranial lesions measuring 2 to 6 mm in diameter with a precision of around 1 mm. It was also possible to produce MR images which relay information of temperature changes in real time, enabling a shift from reversible test heating to irreversible therapeutic heating. This gave rise to the possibility of a minimally-invasive treatment with outcomes similar to those of conventional brain surgery. This method is paving the way to a new future not only in functional neurosurgery, but in cranial neurosurgery targeting conditions such as epilepsy and brain tumors, among others. In this paper, we describe the current state and future outlook of magnetic resonance image guided focused ultrasound, which uses computed tomography (CT) bone images in combination with MRI monitoring of brain temperature.
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Affiliation(s)
- Keiichi Abe
- Department of Neurosurgery, Tokyo Women's Medical University
| | - Takaomi Taira
- Department of Neurosurgery, Tokyo Women's Medical University
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42
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Fishman PS, Frenkel V. Treatment of Movement Disorders With Focused Ultrasound. J Cent Nerv Syst Dis 2017; 9:1179573517705670. [PMID: 28615985 PMCID: PMC5462491 DOI: 10.1177/1179573517705670] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/28/2017] [Indexed: 11/29/2022] Open
Abstract
Although the use of ultrasound as a potential therapeutic modality in the brain has been under study for several decades, relatively few neuroscientists or neurologists are familiar with this technology. Stereotactic brain lesioning had been widely used as a treatment for medically refractory patients with essential tremor (ET), Parkinson disease (PD), and dystonia but has been largely replaced by deep brain stimulation (DBS) surgery, with advantages both in safety and efficacy. However, DBS is associated with complications including intracerebral hemorrhage, infection, and hardware malfunction. The occurrence of these complications has spurred interest in less invasive stereotactic brain lesioning methods including magnetic resonance imaging–guided high intensity–focused ultrasound (FUS) surgery. Engineering advances now allow sound waves to be targeted noninvasively through the skull to a brain target. High intensities of sonic energy can create a coagulation lesion similar to that of older radiofrequency stereotactic methods, but without opening the skull, recent Food and Drug Administration approval of unilateral thalamotomy for treatment of ET. Clinical studies of stereotactic FUS for aspects of PD are underway. Moderate intensity, pulsed FUS has also demonstrated the potential to safely open the blood-brain barrier for localized delivery of therapeutics including proteins, genes, and cell-based therapy for PD and related disorders. The goal of this review is to provide basic and clinical neuroscientists with a level of understanding to interact with medical physicists, biomedical engineers, and radiologists to accelerate the application of this powerful technology to brain disease
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Affiliation(s)
- Paul S Fishman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Victor Frenkel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Rohani M, Fasano A. Focused Ultrasound for Essential Tremor: Review of the Evidence and Discussion of Current Hurdles. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2017; 7:462. [PMID: 28503363 PMCID: PMC5425801 DOI: 10.7916/d8z89jn1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 04/17/2017] [Indexed: 01/09/2023]
Abstract
Background While there is no breakthrough progress in the medical treatment of essential tremor (ET), in the past decades several remarkable achievements happened in the surgical field, such as radiofrequency thalamotomy, thalamic deep brain stimulation, and gamma knife thalamotomy. The most recent advance in this area is magnetic resonance-guided focused ultrasound (MRgFUS). Methods The purpose of this review is to discuss the new developments and trials of MRgFUS in the treatment of ET and other tremor disorders. Results MRgFUS is an incisionless surgery performed without anesthesia and ionizing radiation (no risk of cumulative dose and delayed side effects). Studies have shown the safety and effectiveness of unilateral MRgFUS-thalamotomy in the treatment of ET. It has been successfully used in a few patients with Parkinson’s disease-related tremor, and in fewer patients with fragile X-associated tremor/ataxia syndrome. The safety and long-term effects of the procedure are still unclear, as temporary and permanent adverse events have been reported as well as recurrence of tremor. Discussion MRgFUS is a promising new surgical approach with a number of unknowns and unsolved issues. It represents a valuable option particularly for patients who refused or could not be candidates for other procedures, deep brain stimulation in particular.
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Affiliation(s)
- Mohammad Rohani
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Alfonso Fasano
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital and Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
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44
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Fishman PS, Frenkel V. Focused Ultrasound: An Emerging Therapeutic Modality for Neurologic Disease. Neurotherapeutics 2017; 14:393-404. [PMID: 28244011 PMCID: PMC5398988 DOI: 10.1007/s13311-017-0515-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Therapeutic ultrasound is only beginning to be applied to neurologic conditions, but the potential of this modality for a wide spectrum of brain applications is high. Engineering advances now allow sound waves to be targeted through the skull to a brain region selected with real time magnetic resonance imaging and thermography, using a commercial array of focused emitters. High intensities of sonic energy can create a coagulation lesion similar to that of older radiofrequency stereotactic methods, but without opening the skull. This has led to the recent Food and Drug Administration approval of focused ultrasound (FUS) thalamotomy for unilateral treatment of essential tremor. Clinical studies of stereotactic FUS for aspects of Parkinson's disease, chronic pain, and refractory psychiatric indications are underway, with promising results. Moderate-intensity FUS has the potential to safely open the blood-brain barrier for localized delivery of therapeutics, while low levels of sonic energy can be used as a form of neuromodulation.
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Affiliation(s)
- Paul S Fishman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
| | - Victor Frenkel
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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45
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MRI-Guided Focused Ultrasound in Parkinson's Disease: A Review. PARKINSONS DISEASE 2017; 2017:8124624. [PMID: 28465861 PMCID: PMC5390565 DOI: 10.1155/2017/8124624] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 03/01/2017] [Accepted: 03/15/2017] [Indexed: 11/17/2022]
Abstract
MRI-guided focused ultrasound is a new technology that enables intracranial ablation. Since lesioning ameliorates some of the symptoms of PD, this technology is being explored as a possible treatment for medication resistant symptoms in PD patients. The purpose of this paper is to review the clinical use and treatment outcomes of PD patients treated to date with this technology.
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