Stereotactic Lesion in the Forel's Field H: A 2-Years Prospective Open-Label Study on Motor and Nonmotor Symptoms, Neuropsychological Functions, and Quality of Life in Parkinson Disease

Godinho, Fábio; Magnin, M.; Filho, Paulo Terzian; Reis, Paul Rodrigo; Moraes, Osmar; Nascimento, Marivaldo; Costa, Carlos Daniel Miranda; Oliveira, Maira Okada de; Rocha, Maria Sheila Guimarães

doi:10.1093/neuros/nyz039

Cited by 14 publications

(33 citation statements)

References 36 publications

(49 reference statements)

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“…Surgical technique was previously described (Godinho et al, 2006(Godinho et al, , 2019. Concisely, a tridimensional anatomical targeting was performed by merging a stereotactic Tomography (CT) with a non-stereotactic volumetric 1.5 T Magnetic Resonance Imaging (MRI).…”

Section: Surgical Proceduresmentioning

confidence: 99%

Spectral characteristics of subthalamic nucleus local field potentials in Parkinson's disease: Phenotype and movement matter

Godinho

Neto

Bianqueti

et al. 2021

Eur J of Neuroscience

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Parkinson's disease (PD) is clinically heterogeneous across patients and may be classified in three motor phenotypes: tremor dominant (TD), postural instability and gait disorder (PIGD), and undetermined. Despite the significant clinical characterization of motor phenotypes, little is known about how electrophysiological data, particularly subthalamic nucleus local field potentials (STN‐LFP), differ between TD and PIGD patients. This is relevant since increased STN‐LFP bandpower at α–β range (8–35 Hz) is considered a potential PD biomarker and, therefore, a critical setpoint to drive adaptive deep brain stimulation. Acknowledging STN‐LFP differences between phenotypes, mainly in rest and movement states, would better fit DBS to clinical and motor demands. We studied this issue through spectral analyses on 35 STN‐LFP in TD and PIGD patients during rest and movement. We demonstrated that higher β2 activity (22–35 Hz) was observed in PIGD only during rest. Additionally, bandpower differences between rest and movement occurred at the α–β range, but with different patterns as per phenotypes: movement‐induced desynchronization concerned lower frequencies in TD (10–20 Hz) and higher frequencies in PIGD patients (21–28 Hz). Finally, when supervised learning algorithms were employed aiming to discriminate PD phenotypes based on STN‐LFP bandpower features, movement information had improved the classification accuracy, achieving peak performances when TD and PIGD movement‐induced desynchronization ranges were considered. These results suggest that STN‐LFP β‐band encodes phenotype‐movement dependent information in PD patients.

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Section: Surgical Proceduresmentioning

confidence: 99%

Spectral characteristics of subthalamic nucleus local field potentials in Parkinson's disease: Phenotype and movement matter

Godinho

Neto

Bianqueti

et al. 2021

Eur J of Neuroscience

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“…MoCA reductions at 2 days can be attributed first to postoperative fatigue and second to reductions of thalamocortical reserves (34) in the absence of capsular or MTT encroachments. A valuable way to explore the presence or not of hemispheric significant distributed cell losses is to couple MR imaging (analysis of hemispheric atrophy) with the analysis of cognitive functions, as FIGURE 6 | Comparison of the axial items of the UPDRS III (items 18,19,22,27,28,29,30,31, higher values indicating stronger impairments, max. 32 points) preoperatively (baseline) in on-medication state and 1 year after PTT in off-medication state with its linear regression line.…”

Section: Discussionmentioning

confidence: 99%

“…PTT corresponds to an optimized pallidotomy, because it allows, with very limited tissue ablation, an extensive liberation of the thalamocortical dynamics from pallidal overinhibition (see below), while leaving the thalamus intact. A prospective open-label study and a case report describing similar subthalamic approaches have been recently published (30,31).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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. Gallay et al. MRgFUS PTT for Parkinson's DiseaseConclusion: 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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“…This also removes the need for repeated patient follow up for DBS programming. We also need to take note of some complications noted with tcMRgFUS thalamotomy, such as sensory and gait disturbance [ 22 ]. An inherent limitation of the procedure is its unilaterality.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Magnetic Resonance-Guided Focused Ultrasound in X-Linked Dystonia-Parkinsonism

Jamora

Chang

Taira

2021

Life

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X-linked dystonia-parkinsonism (XDP) is a neurodegenerative condition found among males with maternal ancestry from Panay Island, Philippines. The treatment options are limited. We report on our experience of three XDP patients who underwent transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) pallidothalamic tractotomy. The three patients were all genetically confirmed XDP, with a mean XDP-Movement Disorder Society of the Philippines (MDSP) Scale score of 68.7/200. All patients were on stable doses of their oral medications and their last botulinum toxin injection was 12 months prior to study. Two patients complained of moderate to severe arm pain 2–7 months after the procedure. There was an overall improvement in the XDP-MDSP Scale score of 36.2% (18.7 vs. 15) at 6 months and 30.1% (68.7 vs. 45.5) at 1 year. Notably, there was worsening of the nonmotor subscale (part IIIB, nonbehavioral aspect) by 350% at 1 year. While these numbers are encouraging, there is a need to do a larger study on the safety and efficacy of tcMRgFUS on XDP.

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Stereotactic Lesion in the Forel's Field H: A 2-Years Prospective Open-Label Study on Motor and Nonmotor Symptoms, Neuropsychological Functions, and Quality of Life in Parkinson Disease

Cited by 14 publications

References 36 publications

Spectral characteristics of subthalamic nucleus local field potentials in Parkinson's disease: Phenotype and movement matter

Spectral characteristics of subthalamic nucleus local field potentials in Parkinson's disease: Phenotype and movement matter

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

Transcranial Magnetic Resonance-Guided Focused Ultrasound in X-Linked Dystonia-Parkinsonism

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