Neurosurgical management of non-spastic movement disorders

Role of Neurosurgical Interventions in the Treatment of Movement Disorders Like Parkinson's Disease, Dystonia, and Tourette Syndrome

This article provides an overview of neurosurgical therapies for movement disorders (MDs), including Tourette syndrome, dystonia, Parkinson's disease (PD), and others. It focuses on the benefits of these treatments and suggests directions for further research. A total of 10 years' worth of English-language PubMed articles were combed through, with an emphasis on studies conducted in North America. To manage MDs like Parkinson's disease and Tourette syndrome, the results suggest that non-invasive neuromodulation techniques, closed-loop deep brain stimulation (DBS), and other advanced therapies may become the treatment of choice in the future. Research on dystonia is being focused on improving treatment methods by investigating new areas of the brain that might be stimulated through neurosurgery and looking at gene therapy. Modern technological developments, such as non-invasive neuromodulation procedures and improved imaging, provide promising substitutes for traditional surgical approaches. This study highlights the need for continuous clinical trials for better outcomes, which is why research and development in this area must continue.

Bilateral Simultaneous Magnetic Resonance-Guided Focused Ultrasound Pallidotomy for Life-Threatening Status Dystonicus

BACKGROUND

Invasive treatments like radiofrequency stereotactic lesioning or deep brain stimulation of the globus pallidus internus can resolve drug-resistant status dystonicus (SD). However, these open procedures are not always feasible in patients with SD.

OBJECTIVE

The aim was to report the safety and efficacy of simultaneous asleep bilateral transcranial magnetic resonance-guided focused ultrasound (MRgFUS) pallidotomy for life-threatening SD.

METHODS

We performed bilateral simultaneous MRgFUS pallidotomy under general anesthesia in 2 young patients with pantothenate kinase-associated neurodegeneration and GNAO1 encephalopathy. Both patients had medically refractory SD and severe comorbidities contraindicating open surgery.

RESULTS

SD resolved at 4 and 12 days after MRgFUS, respectively. Adverse events (intraoperative hypothermia and postoperative facial paralysis) were mild and transient.

CONCLUSION

Bilateral simultaneous MRgFUS pallidotomy under general anesthesia is safe and may be a valid alternative therapeutic option for fragile patients. Further studies are needed to assess long-term efficacy of the procedure.

Recent advances in non-Huntington's disease choreas

INTRODUCTION

Chorea is primarily due to an imbalance of basal ganglia output pathways, often due to dysfunction or degeneration of the caudate nucleus and putamen, and can be due to many causes.

METHODS

We reviewed the recent literature to identify newly-recognized causes of chorea, including auto-immune, metabolic, and genetic. We also focused upon developments in mechanisms relating to underlying pathophysiology of certain genetic choreas and advances in therapeutics.

RESULTS

Novel autoantibodies continue to be identified as causes of chorea. Both COVID-19 infection and vaccination are reported to result rarely in chorea, although in some cases causality is not clearly established. Advances in genetic testing continue to find more causes of chorea, and to expand the phenotype of known genetic disorders. Deep brain stimulation can be successful in certain circumstances.

CONCLUSION

Our understanding of mechanisms underlying this movement disorder continues to advance, however much remains to be elucidated.