Bilateral Staged Focused Ultrasound Subthalamotomy in 2 Patients With Parkinson Disease скачать в хорошем качестве

Bilateral Staged Focused Ultrasound Subthalamotomy in 2 Patients With Parkinson Disease

Both patients in all video sections are in the off-medication state. A, This video shows a 49-year-old woman with 6 years of Parkinson disease. In the first section of the video, she presented bilateral but asymmetrical parkinsonism with left predominance. Optimal clinical control was not achievable with medication, partially due to severe behavioral adverse effects resulting from dopaminergic drugs. A right unilateral magnetic resonance–guided focused ultrasound subthalamotomy was proposed. In the second video section, 18 months after treatment, parkinsonism on the left side of her body had largely improved. However, parkinsonism on her right side had progressed, showing tremor and bradykinesia (and rigidity on examination). A left magnetic resonance–guided focused ultrasound subthalamotomy was conducted. In the third video section, when the patient was aged 52 years with 9 years of disease, her Movement Disorders Society–Unified Parkinson Disease Rating Scale score in the off-medication state was 10. Her daily antiparkinsonian drugs consisted of levodopa, 25 mg, and amantadine, 100 mg. She had no motor, speech, cognitive, or behavioral adverse events after treatment. B, This video shows a 49-year-old man with 7 years of Parkinson disease progression at baseline. In the first section of the video, he exhibited practically unilateral parkinsonism, primarily affecting the left side of his body. He did not tolerate medication well, and his motor features were not adequately controlled. A right unilateral magnetic resonance–guided focused ultrasound subthalamotomy was proposed as a treatment option. The second video section shows the patient 3.5 years after the first treatment. His motor signs on the left side of his body had significantly improved. However, medically refractory parkinsonism had developed in the right hemibody. A contralateral left magnetic resonance–guided focused ultrasound subthalamotomy was performed. In the third video section, 6 months later (11 years of disease progression), the patient showed general improvement in his motor condition, scoring 7 points on the Movement Disorders Society–Unified Parkinson Disease Rating Scale III. He was taking pramipexol, 0.26 mg, extended release on a daily basis. This patient experienced hemichorea ballism on the side contralateral to the subthalamic lesion after each of the 2 treatments. As shown in the video, in both instances, it was effectively controlled with a reduction in dopaminergic drug dosage and fully resolved within weeks. He also reported mild speech disturbance after the second ablation, which resolved spontaneously. Click https://ja.ma/3xBmSiN full details.