MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience

Gallay, Marc N.; Moser, David; Rossi, Franziska; Magara, Anouk E.; Strasser, Maja; Bühler, Robert; Kowalski, Milek; Pourtehrani, Payam; Dragalina, Christian; Federau, Christian; Jeanmonod, Daniel

doi:10.3389/fsurg.2019.00076

Cited by 44 publications

(71 citation statements)

References 63 publications

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“…Considering the possible complications and long-term effects, DBS is a safer surgical treatment compared to ablative treatments. Focused ultrasound pallidothalamic tractotomy, which allows for ablative lesions without an incision, is a safe and effective procedure for Parkinson’s disease [ 20 ]. However, bilateral pallidothalamic tractotomy using focused ultrasound also induced hypophonia [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Focused ultrasound pallidothalamic tractotomy, which allows for ablative lesions without an incision, is a safe and effective procedure for Parkinson’s disease [ 20 ]. However, bilateral pallidothalamic tractotomy using focused ultrasound also induced hypophonia [ 20 ]. The possible risks of bilateral focused ultrasound ablations may be same as those of bilateral radiofrequency ablations.…”

Section: Discussionmentioning

confidence: 99%

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Successful Treatment of Auricular Dystonia by Unilateral Pallidothalamic Tractotomy

Kim

Horisawa

Kohara

et al. 2021

Tremor and Other Hyperkinetic Movements

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Background: Ear movement disorders are rarely reported. Although some patients may respond to botulinum toxin injections, reports on surgical treatment options remain limited. Case Report: A 57-year-old woman was diagnosed with auricular dystonia, which was refractory to botulinum toxin injections. Since involuntary movement and pain were predominantly present on the right side and the patient rejected the implantation of a mechanical device, we decided to perform left pallidothalamic tractotomy. Immediately following lesioning, bilateral ear movements and right auricular pain ceased with no complications. Discussion: Stereotactic neurosurgical treatment can be an alternative for auricular dystonia. Highlights: Ear movement disorders, such as auricular myoclonus or dystonia, are rarely reported. The present case was refractory to repetitive botulinum toxin injections and oral medications. To the best of our knowledge, this is the first case of auricular dystonia that successfully improved with stereotactic neurosurgical treatment (pallidothalamic tractotomy).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Auricular Dystonia by Unilateral Pallidothalamic Tractotomy

Kim

Horisawa

Kohara

et al. 2021

Tremor and Other Hyperkinetic Movements

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“…The selection criteria for MRgFUS PTT were described previously ( 22 ). Only mixed and tremor-dominant PD forms were considered in this study.…”

Section: Methodsmentioning

confidence: 99%

“…All procedures were performed in a 3T MR imaging system (GE Discovery 750, GE Healthcare, Milwaukee, WI, USA) using the ExAblate Neuro device (InSightec, Haifa, Israel). A standardized bilateral PTT was performed according to previously published protocol ( 22 , 32 ) either concomitantly or in two sessions. For each target, five to seven sub-units of 1.5 × 1.5 × 3.0 mm were placed.…”

Section: Methodsmentioning

confidence: 99%

“…Our current approach, i.e., targeting the pallidal efferent fibers in the subthalamus, was proposed by Meyers ( 17 ) and later developed by others ( 18 , 19 ). It was re-actualized by Jeanmonod and co-workers first with RF ( 20 , 21 ) and since 2011 with MR-guided focused ultrasound (MRgFUS) ( 22 , 23 ). It was proposed to target specifically the pallidothalamic tract just below the thalamus at the level of Forel's field H1, where the ansa lenticularis and the fasciculus lenticularis converge ( 24 ).…”

Section: Introductionmentioning

confidence: 99%

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Bilateral MR-Guided Focused Ultrasound Pallidothalamic Tractotomy for Parkinson's Disease With 1-Year Follow-Up

et al. 2021

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Objective: Bilateral stereotactic neurosurgery for advanced Parkinson's disease (PD) has a long history beginning in the late 1940s. In view of improved lesioning accuracy and reduced bleeding risk and in spite of long-standing caveats about bilateral approaches, there is a need to investigate bilateral MR-guided focused ultrasound (MRgFUS) interventions. We hereby present the clinical results of bilateral pallidothalamic tractotomy (PTT), i.e., targeting of pallidal efferent fibers below the thalamus at the level of Forel's field H1, followed for 1 year after operation of the second side.Methods: Ten patients suffering from chronic and therapy-resistant PD having received bilateral PTT were followed for 1 year after operation of the second side. The primary endpoints included the Unified Parkinson's Disease Rating Scale (UPDRS) scores in on- and off-medication states, dyskinesias, dystonia, sleep disturbances, pain, reduction in drug intake, and assessment by the patient of her/his global symptom relief as well as tremor control.Results: The time frame between baseline UPDRS score and 1 year after the second side was 36 ± 15 months. The total UPDRS score off-medication at 1 year after the second PTT was reduced by 52% compared to that at baseline on-medication (p < 0.007). Percentage reductions of the mean scores comparing 1 year off- with baseline on-medication examinations were 91% for tremor (p = 0.006), 67% for distal rigidity (p = 0.006), and 54% for distal hypobradykinesia (p = 0.01). Gait and postural instability were globally unchanged to baseline (13% improvement of the mean, p = 0.67, and 5.3% mean reduction, p = 0.83). Speech difficulties, namely, hypophonia, tachyphemia, and initiation of speech, were increased by 58% (p = 0.06). Dyskinesias were suppressed in four over four, dystonia in four over five, and sleep disorders in three over four patients. There was 89% pain reduction. Mean L-Dopa intake was reduced from 690 ± 250 to 110 ± 190.Conclusions: Our results suggest an efficiency of bilateral PTT in controlling tremor, distal rigidity, distal hypobradykinesia, dyskinesias, dystonia, and pain when compared to best medical treatment at baseline. Larger series are of course needed.

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Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

Horisawa

Kohara

Nonaka

et al. 2022

Ann Clin Transl Neurol

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Background Neurosurgical ablation of Forel's field H1 for cervical dystonia, which is currently abandoned, was formerly used in the 1960s–1970s. Regardless of the lack of neuroimaging modalities and objective evaluation scales, the reported efficacy was significant. Although recent studies have reappraised the ablation of the pallidothalamic tract at Forel's field H1 for Parkinson's disease, the efficacy for cervical dystonia has not been investigated well. Methods Data of 35 patients with cervical dystonia who underwent unilateral pallidothalamic tractotomy at Forel's field H1 were retrospectively analyzed. The Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) scores, the neck score of the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), and adverse events were evaluated preoperatively and at the last available follow‐up period. Results The mean clinical follow‐up period was 13.9 ± 6.5 months. The mean TWSTRS total scores were 34.3 ± 14.0 preoperatively and 18.4 ± 16.5 at the last available follow‐up period (46.4% improvement, p < 0.0001). The BFMDRS neck score also improved significantly from 6.2 ± 2.9 preoperatively to 2.8 ± 2.8 at the last available follow‐up period (55.0% improvement on the neck score, p < 0.0001). Reduced hand dexterity in seven patients, hypophonia in five patients, dysarthria in four patients, and executive dysfunction in one patient were confirmed as adverse events at the last available follow‐up evaluation. One patient had postoperative hemorrhage. Conclusion The current study confirmed significant improvement in TWSTRS total scores and BFMDRS neck scores at the 13.9‐month follow‐up after unilateral pallidothalamic tractotomy. The pallidothalamic tract in Forel's field H1 is expected to be an alternative treatment target for cervical dystonia.

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MRgFUS Pallidothalamic Tractotomy for Chronic Therapy-Resistant Parkinson's Disease in 51 Consecutive Patients: Single Center Experience

Cited by 44 publications

References 63 publications

Successful Treatment of Auricular Dystonia by Unilateral Pallidothalamic Tractotomy

Successful Treatment of Auricular Dystonia by Unilateral Pallidothalamic Tractotomy

Bilateral MR-Guided Focused Ultrasound Pallidothalamic Tractotomy for Parkinson's Disease With 1-Year Follow-Up

Unilateral pallidothalamic tractotomy at Forel's field H1 for cervical dystonia

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