Surgical Treatment of Parkinson Disease

Mitchell, Kyle T.; Ostrem, Jill L.

doi:10.1016/j.ncl.2020.01.001

Cited by 14 publications

(11 citation statements)

References 67 publications

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“…79 Surgical ablation of the Vim (thalamotomy) or GPi (pallidotomy) are other alternatives for frail PD patients, and have been considered reasonable solutions for patients with contraindication to DBS experiencing severe tremor or dyskinesias (Table 1). 80 Indeed, LCIG might not be a good option in these cases as tremor is well-known to be often L-dopa-resistant and also because troublesome dyskinesias might not be well controlled especially in the long term. 81 Ablations can be performed with radiofrequency (over 40 years of experience and widely available), radiations (gamma knife radiosurgery) or focused ultrasound (FUS).…”

Section: Alternatives To Dbs Therapy In the Elderlymentioning

confidence: 99%

Surgical Management of Parkinson's Disease in the Elderly

Azevedo

Aquino

Fasano

2021

Movement Disord Clin Pract

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BackgroundBackground: Deep Brain Stimulation (DBS) is an increasingly popular therapy for Parkinson's Disease (PD). Despite the experience gained over time with DBS of either the subthalamus or the globus pallidus pars interna, there is still no consensus regarding the age limit for DBS indication. Objectives Objectives: This narrative review of the literature discusses the issues of age and DBS, emphasizing the critical need for good quality evidence to support the surgical management of elderly patients with PD. Methods Methods: We searched PubMed using the terms Parkinson's Disease; Parkinson's Disease therapy; deep brain stimulation; antiparkinsonian agents therapeutic use; age factors; aged; aged, 80 and over; middle aged; treatment outcome; and risk assessments. ResultsResults: We identified several limitations of the available evidence, such as under-representation of older patients in DBS studies, small sample sizes in studies with older participants, heterogeneity of outcomes, and conflicting results. Conclusions Conclusions: Despite preliminary suggestions that age might affect the outcomes of DBS, the evidence to support the hypothesis of age as an independent predictor of DBS outcomes is limited and results are controversial. Ultimately, finding an age-independent biomarker predicting DBS outcome is the final goal to expand this powerful treatment to all patients age in an effective and safe manner.

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Section: Alternatives To Dbs Therapy In the Elderlymentioning

confidence: 99%

Surgical Management of Parkinson's Disease in the Elderly

Azevedo

Aquino

Fasano

2021

Movement Disord Clin Pract

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“…Оригинальная работа методов, изначально предложенных именно для выполнения функциональных нейрохирургических процедур, является радиохирургия. Результаты радиохирургических вмешательств, проводимых уже в течение длительного времени, позволяют рассматривать радио хирургическую таламотомию как возможный способ устранения паркинсонического тремора [5]. Однако в нашей стране, где сам метод однократного высокодозного стереотаксического облучения активно применяется только последние 15 лет, роль радиохирургии в лечении симптомов болезни Паркинсона менее определенна.…”

Section: Russian Journal Of Neurosurgeryunclassified

“…2) [12]. При определении координаты x учитывали индивидуальную ширину таламуса, границу обсуждение Хирургические стереотаксические таламотомии и паллидотомии начали применяться для лечения тремора у пациентов с болезнью Паркинсона до появления препаратов леводопы, которые на сегодняшний день являются основным методом лечения этого заболевания [2,5]. Однако возрастание частоты побочных эффектов и осложнений лекарственной терапии привело к возобновлению интереса к хирургическому лечению в 90-х годах XX в. Это произошло во многом благодаря работам L. Laitinen и соавт., показавших, что, в отличие от терапии препаратами леводопы, стереотаксические вмешательства способны устранять многие симптомы этого заболевания без значительных побочных эффектов [14].…”

Section: Russian Journal Of Neurosurgeryunclassified

Radiosurgical treatment of medically refractory Parkinson’s tremor

Ivanov

Zubatkina

Butovskaya³

et al. 2021

Nejrohirurgiâ (Mosk.)

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Introduction. In spite of medication treatment being today the basic form of treatment for Parkinson’s disease, surgical methods may be preferable to improve symptoms of the disease. Radiosurgery is one of them, but in Russia, to date, there are no publications summarizing data about the experience of using this method throughout the country.The study objective is to evaluate the effect of radiosurgical thalamotomy (destruction of the intermediate ventral nucleus of the thalamus) on the severity of tremor in patients with Parkinson’s disease, as well as to estimate the frequency of complications of this intervention, the frequency of different variants of radiological and clinical-neurological response.Materials and methods. One hundred and one (101) patients with medically refractory Parkinson’s tremor received Gamma Knife radiosurgery in our centre over a 10‑year period, of whom 10 patients were treated bilaterally. Pre-treatment evaluation was done using tremor assessment scales and video recordings of tremor intensity. Gamma Knife radiosurgery was provided with Leksell Gamma Knife 4C and Leksell Gamma Knife Perfexion (Elekta AB, Sweden) preceded by magnetic resonance tractography the day before treatment. The same planning protocol was used for all patients, the target was ventral intermediate nucleus and the prescription dose of 130 Gy was delivered with a 4 mm isocenter. After treatment, patients were evaluated radiologically and neurologically at regular 6‑month intervals, as well as through telephone interviews and video recordings.Results. Ninety-two (92) patients were included in the analysis of the results of radiosurgical treatment. Median follow-up time after radiosurgery was 26 months, from 6 to 113 months. Tremor reduction was achieved in 76 % of the patients, 61 % of whom had almost complete tremor arrest. Decreased tremors were observed from 1 to 6 months after treatment, with a mean of 4 months. Three (3) patients experienced tremor resurgence after 3–7 years. Complications were observed in 6.5 % of patients and were transient in character. Some of the patients developed severe depression. Only 1 patient had a serious complication in the form of thalamic haemorrhage (at 22 months after treatment). Ten (10) patients who were treated bilaterally all showed considerable clinical improvement and absence of complications.Conclusion. Gamma Knife radiosurgery is a safe and effective functional neurosurgical procedure for tremor correction to improve patients’ quality of life, especially when deep brain stimulation is not accessible. Patients with severe medically refractory tremors are good candidates for Gamma Knife treatment, which showed high efficacy and a low risk of complications.

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“…However, the computational efficiency is still greatly improved. Eventually, n was chosen to be 10 2 to achieve a good compromise between real-time performance and accuracy of the hardware implementation of the neuron model.…”

Section: The Validation Of H ( ) Vmentioning

confidence: 99%

“…Apart from static tremor, myotonia, and some non-motor symptoms [4], abnormal brain oscillatory activities are a typical clinical manifestation of PD [5]. As an alternative of medical [6]- [8] and surgical treatments [9], [10], deep brain stimulation (DBS) is a device-based therapy that has high efficiencies and fewer side-effects in clinical treatment for PD [11]. This therapy uses a stereotactic technique to implant microelectrodes into the Basal Ganglia (BG) [12], [15], the focal area of PD, and to emit continuous high-frequency electrical pulses to stimulate targets including the subthalamic nucleus (STN) or the globus pallidus interna (GPi) with the aim of diminishing abnormal brain rhythms to alleviate disease symptoms [13]- [16].…”

Section: Introductionmentioning

confidence: 99%

An Embedded Multi-Core Real-Time Simulation Platform of Basal Ganglia for Deep Brain Stimulation

Wei

Zhang

Gong

et al. 2021

IEEE Trans. Neural Syst. Rehabil. Eng.

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Closed-loop deep brain stimulation (DBS) paradigm is gaining tremendous favor due to its potential capability of further and more efficient improvements in neurological diseases. Preclinical validation of closed-loop controller is quite necessary in order to minimize injury risks of clinical trials to patients, which can greatly benefit from real-time computational models and thus potentially reduce research and development costs and time. Here we developed an embedded multi-core real-time simulation platform (EMC-RTP) for a biological-faithful computational network model of basal ganglia (BG). The single neuron model is implemented in a highly real-time manner using a reasonable simplification. A modular mapping architecture with hierarchical routing organization was constructed to mimic the pathological neural activities of BG observed in parkinsonian conditions. A closed-loop simulation testbed for DBS validation was then set up using a host computer as the DBS controller. The availability of EMC-RTP and the testbed system was validated by comparing the performance of open-loop and proportional-integral (PI) controllers. Our experimental results showed that the proposed EMC-RTP reproduces abnormal beta bursts of BG in parkinsonian conditions while meets requirements of both real-time and computational accuracy as well. Closed-loop DBS experiments using the EMC-RTP suggested that the platform could perform reasonable output under different kinds of DBS strategies, indicating the usability of the platform.

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Surgical Treatment of Parkinson Disease

Cited by 14 publications

References 67 publications

Surgical Management of Parkinson's Disease in the Elderly

Surgical Management of Parkinson's Disease in the Elderly

Radiosurgical treatment of medically refractory Parkinson’s tremor

An Embedded Multi-Core Real-Time Simulation Platform of Basal Ganglia for Deep Brain Stimulation

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