MRgFUS Pallidothalamic Tractotomy for Therapy-Resistant Parkinson's Disease

Study Overview
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Brief Summary
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To investigate the neural mechanism of Magnetic resonance-guided focused ultrasound (MRgFUS) Pallidothalamic Tractotomy in Parkinson's disease through multi-model MRI, and identify imaging biomarkers for triaging candidates and predicting the clinical outcomes. Parkinson's disease (PD) is the second most progressive neurodegenerative disease with many motor and non-motor symptoms, which brings heavy burden to the family and the society. MRgFUS pallidothalamic tractotomy allows to address all symptoms of PD without skull opening and with very limited tissue ablation, but with varying effectiveness. The unknown pathogenesis of PD has greatly contributed to this variance. Therefore, in order to optimize the clinical application of MRgFUS pallidothalamic tractotomy, it is important to reveal the pathogenesis of Parkinson's disease by using multiple modality MRI methods, and identify imaging biomarkers to triage suitable candidates and predict clinical outcomes.

Detailed Description
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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

Official Title
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Multimodal Magnetic Resonance Imaging Study for MRgFUS Pallidothalamic Tractotomy for Therapy-Resistant Parkinson's Disease

Conditions
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Parkinson Disease, Magnetic Resonance Imaging

Intervention / Treatment
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* Procedure: MR-guided focused ultrasound


Participation Criteria
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Eligibility Criteria
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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.

Ages Eligible for Study
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Minimum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Parkinson's disease<br>The cohort includes patients with Parkinson's disease who underwent MRgFUS pallidothalamic tractotomy (PTT). | Procedure: MR-guided focused ultrasound<br>* MR-guided focused ultrasound pallidothalamic tractotomy is a minimally invasive and effective procedure for thetreatment of Parkinson's disease(PD) patients.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| primary efficacy outcome | The primary endpoints at 6 months and 1 year postoperatively were the Unified Parkinson's Disease Rating Scale (UPDRS) scores. | 1 year | 
| primary safety outcome | Primary safety outcome was assessed by monitoring the incidence and severity of the procedure-related adverse events from the procedure through 1 year after treatment for all patients. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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MR-guided focused ultrasound, pallidothalamic tractotomy