MRgFUS Pallidothalamic Tractotomy for Therapy-Resistant Parkinson's Disease

Treatment scheme:

All patients will first receive uni- or bilateral MRgFUS PTT. As to bilateral interventions, the second one will take place at least 6 months after the first PTT. Patients with unilateral intervention will be followed to 1 year. Patients with bilateral interventions will be followed to 1 year after the second intervention. Baseline clinical demographics, Unified Parkinson Disease Rating Scale (UPDRS), treatment parameters (energy, power, duration time, temperature, target location) , associated adverse effects were recorded.

Imaging protocols:

T2; T2 Flair; DWI; ESWAN; MRS; 3D ASL 2.0s; 3D-T1; DTI; rs-functional MRI

Imaging evaluation:

• Lesion appearance and volume are measured by T2, T2 Flair, DWI, ESWAN, 3D-T1;
• ESWAN and MRS manifests the changes of iron deposition and metabolism, respectively;
• ASL shows regional cerebral blood flow associated with the procedure;
• DTI demonstrates the destruction of white matter integrity.
• Rs-functional MRI reflects alterations of resting-state brain activity.

Treatment:

MRgFUS pallidothalamic tractotomy

Follow-up:

MRI + clinical evaluation: Baseline, 3-day, 1-week, 1-month, 3-months, 6-months,12-months

Inclusion criteria

• Regardless of sex, aged 30 or above, hope to treat bilateral motor symptoms and receive the other side treatment plan at the 6th month;
• Subjects are able and willing to give informed consent and can participate in whole study visits;
• It was clinically diagnosed as Parkinson's disease and confirmed by functional neurosurgeons;
• The subjects should respond to levodopa;
• In the off-medication state, the subjects' MDS-UPDRS scores were 30 or more.

Exclusion criteria

• The subjects scored 3 or more in the pull-back test;
• Parkinson's disease symptoms were suspected as the side effects of antipsychotics;
• severe cognitive impairment confirmed by neuropsychologists;
• subjects with other neurodegenerative diseases;
• Subjects with unstable mental illness, defined as active, uncontrolled depression, schizophrenia, delusions, hallucinations or suicide intention;
• Pregnant or lactating women;
• Subjects with alcohol or drug abuse;
• Subjects with unstable heart condition or severe hypertension;
• Subjects with a history of abnormal bleeding or clotting.