MR-guided focused ultrasound pallidotomy for Parkinson’s disease: safety and feasibility
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Le résumé fourni par la source
OBJECTIVE: Stereotactic radiofrequency pallidotomy has demonstrated improvement in motor fluctuations in patients with Parkinson's disease (PD), particularly levodopa (L-dopa)-induced dyskinesias. The authors aimed to determine whether or not unilateral pallidotomy with MR-guided focused ultrasound (MRgFUS) could safely improve Unified Dyskinesia Rating Scale (UDysRS; the primary outcome measure) scores over baseline scores in patients with PD. METHODS: Twenty patients with PD and L-dopa responsiveness, asymmetrical motor signs, and motor fluctuations, including dyskinesias, participated in a 1-year multicenter open-label trial of unilateral MRgFUS ablation of the globus pallidus internus. RESULTS: The sonication procedure was successfully completed in all 20 enrolled patients. MRgFUS-related adverse neurological events were generally mild and transient, including visual field deficit (n = 1), dysarthria (n = 4, 2 mild and 2 moderate), cognitive disturbance (n = 1), fine motor deficit (n = 2), and facial weakness (n = 1). Although 3 adverse events (AEs) were rated as severe (transient sonication-related pain in 2, nausea/vomiting in 1), no AE fulfilled US FDA criteria for a Serious Adverse Effect. Total UDysRS, the primary outcome measure, improved 59% after treatment (baseline mean score 36.1, 95% CI 4.88; at 3 months 14.2, 95% CI 5.72, p < 0.0001), which was sustained throughout the study (at 12 months 20.5, 95% CI 7.39, 43% improvement, p < 0.0001). The severity of motor signs on the treated side (Movement Disorder Society version of the United Parkinson's Disease Rating Scale [MDS-UPDRS] part III) in the "off" medication state also significantly improved (baseline mean score 20.0, 95% CI 2.4; at 3 months 10.6, 95% CI 1.86, 44.5% improvement, p < 0.0001; at 12 months 10.4, 95% CI 2.11, 45.2% improvement, p > 0.0001). The vast majority of patients showed a clinically meaningful level of improvement on the impairment component of the UDysRS or the motor component of the UPDRS, while 1 patient showed clinically meaningful worsening on the UPDRS at month 3. CONCLUSIONS: This study supports the feasibility and preliminary efficacy of MRgFUS pallidotomy in the treatment of patients with PD and motor fluctuations, including dyskinesias. These preliminary data support continued investigation, and a placebo-controlled, blinded trial is in progress. Clinical trial registration no.: NCT02263885 (clinicaltrials.gov).
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- MR-guided focused ultrasound pallidotomy for Parkinson’s disease: safety and feasibility
- Date Crossref
- 01/09/2021
- Éditeur
- Journal of Neurosurgery Publishing Group (JNSPG)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
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Neurosurgery Research & Education Foundation pays non établi dans la noticeOrganisation à but non lucratif
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The Ohio State University Wexner Medical Center pays non établi dans la noticeÉtablissement de santé
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The Ohio State University pays non établi dans la noticeUniversité ou école supérieure
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University of Virginia Health System pays non établi dans la noticeÉtablissement de santé
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University of Virginia Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Brigham and Women's Hospital Department of Neurosurgery pays non établi dans la noticeÉtablissement de santé
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University of Maryland Neurology pays non établi dans la noticeUniversité ou école supérieure
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Ohio State University Medical Center Department of Neurosurgery pays non établi dans la noticeUniversité ou école supérieure
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Neurosurgery Research & Education Foundation, The Ohio State University Wexner Medical Center et The Ohio State University, avec 8 autres affiliations.
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