Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel and minimally invasive technology. Since the US Food and Drug Administration approved unilateral ventral intermediate nucleus-MRgFUS for medication-refractory essential tremor in 2016, studies on new indications, such as Parkinson's disease (PD), psychiatric diseases, and brain tumors, have been on the rise, and MRgFUS has become a promising method to treat such neurological diseases. Currently, as the second most common degenerative disease, PD is a research hotspot in the field of MRgFUS. The actions of MRgFUS on the brain range from thermoablation, blood-brain barrier (BBB) opening, to neuromodulation. Intensity is a key determinant of ultrasound actions. Generally, high intensity can be used to precisely thermoablate brain targets, whereas low intensity can be used as molecular therapies to modulate neuronal activity and open the BBB in conjunction with injected microbubbles. Here, we aimed to summarize advances in the application of MRgFUS for the treatment of PD, with a focus on thermal ablation, BBB opening, and neuromodulation, in the hope of informing clinicians of current applications.
Humans ; Parkinson Disease/therapy* ; Brain ; Blood-Brain Barrier ; Essential Tremor/surgery* ; Brain Neoplasms ; Magnetic Resonance Imaging/methods* ; Magnetic Resonance Spectroscopy

Deep brain stimulation (DBS) surgery is an important treatment for patients with Parkinson's disease in the middle and late stages. The accuracy of the implantation of electrode at the location of the nuclei directly determines the therapeutic effect of the operation. At present, there is no single imaging method that can obtain images with electrodes, nuclei and their positional relationship. In addition, the subthalamic nucleus is small in size and the boundary is not obvious, so it cannot be directly segmented. In this paper, a complete end-to-end DBS effect evaluation pipeline was constructed using magnetic resonance (MR) data of T1, T2 and SWI weighted by DBS surgery. Firstly, the images of preoperative and postoperative patients are registered and normalized to the same coordinate space. Secondly, the patient map is obtained by non-rigid registration of brain map and preoperative data, as well as the preoperative nuclear cluster prediction position. Then, a three-dimensional (3D) image of the positional relationship between the electrode and the nucleus is obtained by using the electrode path in the postoperative image and the result of the nuclear segmentation. The 3D image is helpful for the evaluation of the postoperative effect of DBS and provides effective information for postoperative program control. After analysis, the algorithm can achieve a good registration between the patient's DBS surgical image and the brain map. The error between the algorithm and the expert evaluation of the physical coordinates of the center of the thalamus is (1.590 ± 1.063) mm. The problem of postoperative evaluation of the placement of DBS surgical electrodes is solved.
Brain Mapping ; methods ; Deep Brain Stimulation ; Electrodes, Implanted ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; Multimodal Imaging ; Parkinson Disease ; surgery ; Subthalamic Nucleus

OBJECTIVETo investigate clinical efficacy and experience of total knee arthroplasty in treating knee osteoarthritis patients with Parkinson's disease.

METHODSFrom January 2011 to January 2014, 19 knee osteoarthritis patients with Parkinson's disease treated with total knee arthroplasty were collected. Among them, including 9 males and 10 females aged from 61 to 83 years old with an average of 71.3 years old. Radiology results were checked before and after operation. VAS score and KSS score were applied to evaluate clinical effects. Patients were classified according to HoehnYahr grade, 3 cases in grade 1, 4 cases in grade 1.5, 2 cases in grade 2, 4 cases in grade 2.5, 2 cases in grade 3 and 1 case in grade 4.

RESULTSNineteen patients were followed up from 3 to 7 years with an average of 4.3 years. The pain of patients was significantly reduced or disappeared. All incisions were healed at stage I. At the latest follow-up, 3 patients had knee pain, and mild pain in 1 patient, moderate in 1 patient without severe pain. VAS score was reduced from preoperative 8.4±1.3 to the latest follow-up 3.1±1.2, the difference was statistically significant (0.05). KSS score improved from 43.6±7.3 before operation to 91.8±10.6 after operation. The condition of Parkinson's were controlled by medicine. No loosening and subsidence of prosthesis by X-ray examination.

CONCLUSIONSTotal knee arthroplasty is a safe and effective method for the treatment of Parkinson's disease and has satisfactory mid-term clinical effect.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; Knee Prosthesis ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Parkinson Disease ; complications ; Retrospective Studies ; Treatment Outcome

OBJECTIVEThis review examines the evidence that deep brain stimulation (DBS) has extensive impact on nonmotor symptoms (NMSs) of patients with Parkinson's disease (PD).

DATA SOURCESWe retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus (GPi), subthalamic nucleus (STN), and ventral intermediate thalamic nucleus.

STUDY SELECTIONWe included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs: Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups: those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS.

RESULTSIn general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS; The impact of DBS on behavioral addictions and dysphagia is still uncertain.

CONCLUSIONSAs the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients.

Deep Brain Stimulation ; Globus Pallidus ; surgery ; Humans ; Male ; Parkinson Disease ; surgery ; therapy ; Subthalamic Nucleus ; surgery

BACKGROUNDParkinson's disease (PD) is an extrapyramidal neurological disorder. Urinary symptoms are frequently present in patients affected by PD. Symptoms such as urgency, frequency, nocturia, and urge incontinence significantly impact the patient's quality of life. We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.

METHODSComprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction. Appropriate treatments were given to subgroups that were divided based on test results, and the changes in urodynamic parameters as well as the treatment efficacy were observed.

RESULTSDetrusor hyperreflexia without bladder outlet obstruction (BOO) was observed in 35 patients, who exhibited significant improvements in the international prostate symptom score (IPSS), maximum flow rate (Qmax), bladder volume at the first desire to void, post-void residual (PVR), and bladder compliance. Detrusor hyperreflexia associated with BOO was observed in 59 patients. The patients exhibited significant improvements in IPSS, Qmax, PVR, and bladder compliance. Detrusor dysfunction without BOO was observed in 19 patients, for whom the IPSS and the bladder volume at the first desire to void were improved after treatment. Detrusor dysfunction with BOO was found in 28 patients, with no significant improvement in the urodynamic parameters after the treatment.

CONCLUSIONSUrodynamic examination is recommended for male Parkinson's disease patients with voiding dysfunction. Early and effective treatment can improve the bladder function and quality of life of these patients.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Parkinson Disease ; physiopathology ; surgery ; therapy ; Urination Disorders ; physiopathology ; surgery ; therapy ; Urodynamics

BACKGROUNDThe accuracy of microelectrode-guided localization can make the operation safe and effective, but only experienced neurosurgeons are capable of performing this operation. A good index to identify neuronal discharges between globus pallidus interna and globus pallidus externa is needed. The aim of this research was to establish a good and practical electrophysiologic index to distinguish neuronal discharge in the interior globus pallidus from neuronal discharge in the exterior globus pallidus region of the brain in Parkinson's disease. The effect of neurons having an atypical discharge on successful surgical localization was also quantitatively evaluated.

METHODSThe study included 30 patients with primary Parkinson's disease who underwent pallidotomy between September 2000 and October 2002. During each pallidotomy, the neuronal discharges in the pallidum and its vicinity were recorded. The recorded spikes were used to calculate the frequency, burst index, pause index, and pause ratio of the single-unit discharge. The interior and exterior globus pallidus regions were compared in terms of frequency, burst index, pause index, and pause ratio. The sensitivity, specificity, false-negative ratio, false-positive ratio, and accuracy of those indices were then evaluated.

RESULTSThe values of frequency, burst index, pause index, and pause ratio in the interior globus pallidus were (96 +/- 43) Hz, 2.31 +/- 1.81, 0.05 +/- 0.05, and 0.27 +/- 0.28, respectively, and in the exterior globus pallidus were (59 +/- 27) Hz, 0.88 +/- 0.63, 0.20 +/- 0.14, and 1.54 +/- 1.17, respectively. Use of the four indices to distinguish the two neuron types produced a sensitivity of 0.84, 0.78, 0.77, and 0.93 with a specificity of 0.64, 0.79, 0.88, and 0.87, respectively. The false-positive ratio was 0.36, 0.21, 0.12, and 0.13 and the false-negative ratio was 0.16, 0.22, 0.23, and 0.07 while the accuracy was 0.72, 0.79, 0.80, and 0.90, respectively.

CONCLUSIONSPause ratio is a relatively reliable index to distinguish neuronal discharges between the interior and exterior globus pallidus regions in Parkinson's disease. The effect of neurons with atypical discharge on the successful surgical localization would be reduced to 10% when the pause ratio is used as the index.

Adult ; Electrophysiology ; Female ; Globus Pallidus ; metabolism ; Humans ; Male ; Microelectrodes ; Middle Aged ; Pallidotomy ; methods ; Parkinson Disease ; metabolism ; surgery

Currently, the intraoperative location of microelectrode position in the globus pallidus is subjective and qualitative; it only depends on the experience of doctors during pallidotomy for the treatment of Parkinson's disease. The fractal characteristic of neuronal discharge signals is analyzed for target localization; the factor of box dimension is extracted from the microelectrode recordings for identifying the neuronal structures at the depth of microelectrode. New objective and quantitative targeting technique is presented by processing clinical microelelctrode recordings of Parkinson's disease. Through the validation of clinical data and the critical appraisal by experts, the targeting technique can be used for improving the accuracy of localization in neurosurgery.
Electrophysiology ; Globus Pallidus ; physiopathology ; surgery ; Humans ; Microelectrodes ; Neurons ; physiology ; Pallidotomy ; methods ; Parkinson Disease ; physiopathology ; surgery ; Stereotaxic Techniques ; Surgery, Computer-Assisted ; methods

Electrophysiological target localization is the key technology in microelectrode-guided stereotactic neurosurgery for Parkinson's disease (PD). A neuronal discharge signal analysis method based on Hilbert-Huang transform (HHT) was introduced. By decomposing the clinical microelectrode recording (MER) data of PD into intrinsic mode functions (IMFs), the marginal spectrums of IMFs were achieved, and the characteristic factor correlated with brain structure was explored, then the HHT characteristic factor curve of neuronal discharge signals of microelectrode piqure locus could be achieved. The structures of neuronal and boundaries can be distinguished by the characteristic factor curve, and then damage range and damage point can be identified. This method can assist clinicians in ascertaining operation target effectively and researching into the cases of PD.
Electrophysiology ; Humans ; Microelectrodes ; Neurons ; cytology ; physiology ; Neurosurgery ; methods ; Parkinson Disease ; physiopathology ; surgery ; Signal Processing, Computer-Assisted ; Stereotaxic Techniques

Intraoperative analysis of the position of microelectrode in the globus pallidus only depends on experiences and subjective interpretation of microeletrode recording discharge of neurons during pallidotomy for Parkinson's disease. In this paper is reported a method for objective localization of microeletrode during neurosurgery. This method uses the factor of interspike interval based on microelectrode recordings. It is effective for identifying the change of the globus pallidal organism along the microelectrode pathway and the departure or deviation of the needle-pathway. The classification is consistent with the anatomic structures and the results of neurosurgery. This method can be used as a guide in pallidotomy. Globus pallidus.
Adult ; Aged ; Female ; Globus Pallidus ; surgery ; Humans ; Male ; Microelectrodes ; Middle Aged ; Pallidotomy ; methods ; Parkinson Disease ; surgery ; Stereotaxic Techniques ; Surgery, Computer-Assisted ; methods

Animals ; Cell Transplantation ; methods ; Humans ; Parkinson Disease ; surgery ; Pigment Epithelium of Eye ; cytology ; physiology ; Positron-Emission Tomography