Focused ultrasound thalamotomy in Parkinson disease: Nonmotor outcomes and quality of life.

Abstract:

OBJECTIVE:To examine nonmotor outcomes and correlates of quality of life (QoL) 3 and 12 months after unilateral focused ultrasound thalamotomy in tremor-dominant Parkinson disease (TDPD). METHODS:Twenty-seven patients with TDPD in a double-blind, sham-controlled, randomized clinical trial underwent comprehensive neuropsychological evaluations. These included assessment of mood, behavior, and QoL at baseline, 3 months, 3 months post crossover in the sham group, and 12 months after active treatment. We used Mann-Whitney U tests to assess differences between the active (n = 20) and sham (n = 7) groups at 3 months and Friedman tests to assess within-group changes after active treatment. We assessed correlations between disease variables and postoperative QoL using Kendall tau-b tests. RESULTS:There were no differences in cognition, mood, or behavior between the active and sham groups at 3-month blinded assessment. After active treatment, there were no differences in mood or behavior. Only declines in Stroop Color Naming and phonemic fluency were observed. Patients experienced postoperative improvements in QoL and activities of daily living (ADL). Mood and behavioral symptoms, aspects of cognitive functioning, ADL, and overall motor symptom severity, but not tremor severity specifically, were associated with QoL. CONCLUSIONS:In TDPD, unilateral focused ultrasound thalamotomy appears safe from a cognitive, mood, and behavioral perspective. QoL and ADL significantly improved following surgery. Nonmotor symptoms and ADL were more closely associated with QoL than tremor severity. CLASSIFICATION OF EVIDENCE:This study provides Class II evidence that for patients with TDPD, unilateral focused ultrasound thalamotomy did not adversely change cognition, mood, or behavior at 3 months.

journal_name

Neurology

journal_title

Neurology

authors

Sperling SA,Shah BB,Barrett MJ,Bond AE,Huss DS,Gonzalez Mejia JA,Elias WJ

doi

10.1212/WNL.0000000000006279

subject

Has Abstract

pub_date

2018-10-02 00:00:00

pages

e1275-e1284

issue

14

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000006279

journal_volume

91

pub_type

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