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Goleij P, Amini A, Tabari MAK, Hadipour M, Sanaye PM, Alsharif KF, Daglia M, Larsen DS, Khan H. The role of interleukin (IL)-2 cytokine family in Parkinson's disease. Cytokine 2025; 191:156954. [PMID: 40318236 DOI: 10.1016/j.cyto.2025.156954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 04/03/2025] [Accepted: 04/24/2025] [Indexed: 05/07/2025]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder, which primarily impacts the nervous system, marked by its immune and inflammatory characteristics. The interleukin-2 (IL-2) cytokine family has a crucial role in regulating both neuroinflammation and immune activity, positioning it as one of the critical immune pathways in PD. Balancing pro-inflammatory and anti-inflammatory signals in PD heavily depends on the IL-2 cytokine family, that includes IL-2, IL-4, IL-7, IL-9, IL-15 and IL-21. This balance is vital for neuron survival and resistance to degeneration. Disruptions in IL-2 signaling can upset the equilibrium among regulatory T cells (Tregs) and pro-inflammatory T cells, such as Th1 and Th17, further aggravating the chronic neuroinflammation typical of PD. In PD, a decline in IL-2 or receptor dysfunction can hinder Treg activity, leading to increased inflammation and neurodegeneration. Similarly, IL-15 and IL-21 supports cytotoxic immune cell function, including natural killer (NK) cells and CD8+ T cells, which may exacerbate neuronal damage by sustaining pro-inflammatory processes. Moreover, IL-4 and IL-7 have anti-inflammatory roles in maintaining T cell homeostasis, and their dysregulation can contribute to interruption of the blood-brain barrier and increased infiltration of immune cells into the central nervous system. Targeting the IL-2 cytokine family in Parkinson's disease has shown therapeutic potential by expanding Tregs, which reduce neuroinflammation and promote dopaminergic neuron survival. Recombinant IL-2 and IL-2/anti-IL-2 complexes have demonstrated efficacy in animal models, enhancing Treg function and leading to improved neuroprotection. Additionally, IL-4-based therapies have been explored for their ability to shift microglia toward a neuroprotective phenotype, further enhancing neuronal survival by modulating inflammatory responses and cellular metabolism. Current research is exploring how to optimize cytokine delivery while minimizing immune side effects, with the goal of developing more targeted therapies for PD.
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Affiliation(s)
- Pouya Goleij
- USERN Office, Kermanshah University of Medical Sciences, Kermanshah 6715847141, Iran; Department of Genetics, Faculty of Biology, Sana Institute of Higher Education, Sari 4816118761, Iran.
| | - Alireza Amini
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran 4815733971, Iran
| | - Mohammad Amin Khazeei Tabari
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran 4815733971, Iran
| | - Mahboube Hadipour
- Department of Biochemistry, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas 7919693116, Iran
| | - Pantea Majma Sanaye
- School of Pharmacy, Zanjan University of Medical Sciences, Zanjan 4513956184, Iran
| | - Khalaf F Alsharif
- Department of Clinical Laboratory Science, College of Applied Medical Science, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Maria Daglia
- Department of Pharmacy, University of Naples "Federico II", Via D. Montesano 49, 80131 Naples, Italy; International Research Center for Food Nutrition and Safety, Jiangsu University, Zhenjiang 212013, China.
| | - Danaé S Larsen
- School of Chemical Sciences, The University of Auckland, 23 Symonds Street, Auckland 1010, New Zealand.
| | - Haroon Khan
- Department of Pharmacy, Faculty of Chemical and Life Sciences, Abdul Wali Khan University Mardan, Mardan 23200, Pakistan; Department of Pharmacy, Korea University, Sejong, 20019, South Korea.
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Valerio JE, Aguirre Vera GDJ, Fernandez Gomez MP, Zumaeta J, Alvarez-Pinzon AM. AI-Driven Advances in Parkinson's Disease Neurosurgery: Enhancing Patient Selection, Trial Efficiency, and Therapeutic Outcomes. Brain Sci 2025; 15:494. [PMID: 40426665 PMCID: PMC12110375 DOI: 10.3390/brainsci15050494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2025] [Revised: 04/30/2025] [Accepted: 05/04/2025] [Indexed: 05/29/2025] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder marked by motor and non-motor dysfunctions that severely compromise patients' quality of life. While pharmacological treatments provide symptomatic relief in the early stages, advanced PD often requires neurosurgical interventions, such as deep brain stimulation (DBS) and focused ultrasound (FUS), for effective symptom management. A significant challenge in optimizing these therapeutic strategies is the early identification and recruitment of suitable candidates for clinical trials. This review explores the role of artificial intelligence (AI) in advancing neurosurgical and neuroscience interventions for PD, highlighting the ways in which AI-driven platforms are transforming clinical trial design and patient selection. Machine learning (ML) algorithms and big data analytics enable precise patient stratification, risk assessment, and outcome prediction, accelerating the development of novel therapeutic approaches. These innovations improve trial efficiency, broaden treatment options, and enhance patient outcomes. However, integrating AI into clinical trial frameworks presents challenges such as data standardization, regulatory hurdles, and the need for extensive validation. Addressing these obstacles will require collaboration among neurosurgeons, neuroscientists, AI specialists, and regulatory bodies to establish ethical and effective guidelines for AI-driven technologies in PD neurosurgical research. This paper emphasizes the transformative potential of AI and technological innovation in shaping the future of PD neurosurgery, ultimately enhancing therapeutic efficacy and patient care.
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Affiliation(s)
- José E. Valerio
- Neurosurgery Innovation and Technology Division, Latinoamerica Valerio Foundation, Weston, FL 33331, USA; (J.E.V.)
- Department of Neurological Surgery, Palmetto General Hospital, Miami, FL 33016, USA
- Neurosurgery Oncology Center of Excellence, Department of Neurosurgery, Miami Neuroscience Center at Larkin, South Miami, FL 33143, USA
- GW School of Business, The George Washington University, Washington, DC 20052, USA
| | - Guillermo de Jesús Aguirre Vera
- Neurosurgery Innovation and Technology Division, Latinoamerica Valerio Foundation, Weston, FL 33331, USA; (J.E.V.)
- Tecnológico de Monterrey School of Medicine, Monterrey 64710, Mexico
| | - Maria P. Fernandez Gomez
- Neurosurgery Innovation and Technology Division, Latinoamerica Valerio Foundation, Weston, FL 33331, USA; (J.E.V.)
| | - Jorge Zumaeta
- Neurosurgery Innovation and Technology Division, Latinoamerica Valerio Foundation, Weston, FL 33331, USA; (J.E.V.)
| | - Andrés M. Alvarez-Pinzon
- Neurosurgery Innovation and Technology Division, Latinoamerica Valerio Foundation, Weston, FL 33331, USA; (J.E.V.)
- The Institute of Neuroscience of Castilla y León (INCYL), Cancer Neuroscience, University of Salamanca (USAL), 37007 Salamanca, Spain
- Cellular Theraphy Program, Universidad de Granada, Hospital Real de Granada, 18071 Granada, Spain
- Institute for Human Health and Disease Intervention (I-HEALTH), Florida Atlantic University, Jupiter, FL 33431, USA
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Baumann CR, Fleisch A, Mahendran S, Uhl M, Freudinger C, Efthymiou E, Oertel MF, Stieglitz LH, Büchele F. Thalamic Deep Brain Stimulation Versus Magnetic Resonance-Guided Focused Ultrasound in Tremor Patients: A Retrospective Single-Surgeon Comparison. Mov Disord 2025; 40:834-843. [PMID: 40013514 DOI: 10.1002/mds.30153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 01/18/2025] [Accepted: 02/03/2025] [Indexed: 02/28/2025] Open
Abstract
BACKGROUND Bilateral deep brain stimulation (DBS) and unilateral magnetic resonance-guided focused ultrasound (MRgFUS), with potential future second-side treatment targeting the thalamic ventral intermediate nucleus (VIM), are currently the two best-established interventions for pharmaco-resistant tremors, but treatment selection is hampered by the lack of comparative evidence. OBJECTIVE To provide the first direct within-center and within-surgeon comparison between bilateral VIM-DBS and unilateral VIM-MRgFUS, applying consistently timed and elaborated efficacy and safety assessements. METHODS In this retrospective study, we included patients having received bilateral VIM-DBS (n = 30) or unilateral VIM-MRgFUS (n = 52) performed by one single neurosurgeon between 2014 and 2022. Efficacy was primarily measured by the improvement of the Washington Heights-Inwood Genetic Study of Essential Tremor scale in the more affected hand at 6 months. Regarding safety, we compared treatment-, procedure-, and hardware-related adverse events (AEs), graded by impact on activities of daily living (ADLs), and serious AEs (SAEs), retrospectively defined based on prolonged/repeated hospitalizations or persistent symptoms affecting ADLs. RESULTS We found equivalent tremor reduction in the more affected hand (DBS: 62.4% [41.3-87.9] vs. MRgFUS: 69.4% [42.4-77.7]; P = 0.958), but contralateral and axial tremors improved only with bilateral DBS. DBS was associated with a higher rate of procedure- and hardware-related AEs (17% vs. 2%; P = 0.023) but a nonsignificantly lower rate of persistent treatment-related AEs affecting ADLs at 6 months (7% vs. 13%; P = 0.343). Overall, the rates of SAEs (23.3% vs. 19.2%; P = 0.779) and persistent deficits affecting ADLs at 6 months (10% vs. 13%; P = 0.82) were similar. CONCLUSIONS Despite distinct safety profiles, both interventions produced a similar burden of AEs. Tremor control was equivalent on the more affected side, whereas contralateral and axial tremors improved only after bilateral DBS. © 2025 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christian Rainer Baumann
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
| | - Andreas Fleisch
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
| | - Sujitha Mahendran
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
| | - Mechtild Uhl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
| | - Carola Freudinger
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
| | - Evdokia Efthymiou
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
| | - Markus Florian Oertel
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Lennart Henning Stieglitz
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Büchele
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
- Clinical Neuroscience Centre, University of Zurich, Zurich, Switzerland
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Kumar R, Kumar R. Intestinal dysbiosis leads to the reduction in neurochemical production in Parkinson's disease (PD). INTERNATIONAL REVIEW OF NEUROBIOLOGY 2025; 180:25-56. [PMID: 40414635 DOI: 10.1016/bs.irn.2025.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2025]
Abstract
Parkinson's Disease (PD) is a neurodegenerative disorder characterized by motor and non-motor symptoms, with emerging research suggesting a critical link between intestinal dysbiosis and PD progression. This review explores the pathophysiological mechanisms underlying PD, such as alpha-synuclein aggregation, mitochondrial dysfunction, neuroinflammation, and oxidative stress, while focusing on the impact of gut dysbiosis on intestinal barrier function and its role in reduced neurochemical production. The clinical features of PD, including dopamine, serotonin, and GABA deficiencies, are examined, with a focus on how dysbiosis contributes to neurotransmitter depletion. Current treatments of PD, such as levodopa and dopamine agonists, are discussed alongside gut health therapies such as probiotics, prebiotics, and Fecal Microbiota Transplantation (FMT). Future therapeutic directions, including synbiotics, engineered microbes, phage therapy, and the integration of machine learning (ML) and artificial intelligence (AI), are explored. The chapter also considers preventive strategies, such as lifestyle adjustments and early gut health monitoring using modern diagnostic tools and biosensors. Furthermore, a strong need for continued research into the gut-brain axis (GBA) to develop more effective, gut-targeted therapies for managing PD is discussed.
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Affiliation(s)
- Rahul Kumar
- Department of Life Sciences, GITAM School of Sciences, GITAM (Deemed to be) University, Visakhapatnam, India
| | - Rahul Kumar
- Department of Life Sciences, GITAM School of Sciences, GITAM (Deemed to be) University, Visakhapatnam, India.
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Guinal SM, Jamora RDG, Khu KJO, Aguilar JA. Magnetic resonance-guided focused ultrasound in dystonia: a scoping review. Neurol Sci 2025; 46:1121-1130. [PMID: 39562491 DOI: 10.1007/s10072-024-07882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 11/05/2024] [Indexed: 11/21/2024]
Abstract
BACKGROUND Magnetic resonance guided focused ultrasound (MRgFUS) is a non-invasive therapeutic technique that utilizes focused ultrasound waves to generate heat at specific tissue targets within the brain. This emerging technology holds promise for its precision and potential benefits in comparison to traditional surgical interventions. This investigation involves a scoping review, summarizing insights from various studies that explore the advantages, limitations, and outcomes associated with MRgFUS in the treatment of dystonia. METHODS This scoping review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. Data available on MRgFUS use in the management of different types of dystonia were extracted. RESULTS There is limited data available (n = 11). In the surveyed literature, MRgFUS has consistently shown clinical benefit in patients with dystonia. It is an emerging avenue of treatment and has its challenges. CONCLUSION This scoping review highlighted the early but encouraging applications of MRgFUS in dystonia management. While data was limited, existing studies consistently demonstrated positive clinical outcomes. The non-invasive and precise nature of MRgFUS positions it as a promising avenue for further research, despite the challenges associated with its emergent status. This review sets the stage for future inquiries, emphasizing its potential as a valuable tool in dystonia treatment.
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Affiliation(s)
- Safrollah M Guinal
- Division of Adult Neurology, Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roland Dominic G Jamora
- Division of Adult Neurology, Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
- Section of Neurology, Department of Internal Medicine, Cardinal Santos Medical Center, San Juan City, Philippines.
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jose A Aguilar
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Ciocca M, Jameel A, Yousif N, Patel N, Smith J, Akgun S, Jones B, Gedroyc W, Nandi D, Tai Y, Seemungal BM, Bain P. Illusions of Self-Motion during Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Tremor. Ann Neurol 2024; 96:121-132. [PMID: 38709569 DOI: 10.1002/ana.26945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE Brain networks mediating vestibular perception of self-motion overlap with those mediating balance. A systematic mapping of vestibular perceptual pathways in the thalamus may reveal new brain modulation targets for improving balance in neurological conditions. METHODS Here, we systematically report how magnetic resonance-guided focused ultrasound surgery of the nucleus ventralis intermedius of the thalamus commonly evokes transient patient-reported illusions of self-motion. In 46 consecutive patients, we linked the descriptions of self-motion to sonication power and 3-dimensional (3D) coordinates of sonication targets. Target coordinates were normalized using a standard atlas, and a 3D model of the nucleus ventralis intermedius and adjacent structures was created to link sonication target to the illusion. RESULTS A total of 63% of patients reported illusions of self-motion, which were more likely with increased sonication power and with targets located more inferiorly along the rostrocaudal axis. Higher power and more inferiorly targeted sonications increased the likelihood of experiencing illusions of self-motion by 4 and 2 times, respectively (odds ratios = 4.03 for power, 2.098 for location). INTERPRETATION The phenomenon of magnetic vestibular stimulation is the most plausible explanation for these illusions of self-motion. Temporary unilateral modulation of vestibular pathways (via magnetic resonance-guided focused ultrasound) unveils the central adaptation to the magnetic field-induced peripheral vestibular bias, leading to an explicable illusion of motion. Consequently, systematic mapping of vestibular perceptual pathways via magnetic resonance-guided focused ultrasound may reveal new intracerebral targets for improving balance in neurological conditions. ANN NEUROL 2024;96:121-132.
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Affiliation(s)
- Matteo Ciocca
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Ayesha Jameel
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Nada Yousif
- School of Engineering and Computer Science, University of Hertfordshire, Hatfield, United Kingdom
| | - Neekhil Patel
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Joely Smith
- Faculty of Engineering, Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Sena Akgun
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Brynmor Jones
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Wlayslaw Gedroyc
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dipankar Nandi
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Yen Tai
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Barry M Seemungal
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
| | - Peter Bain
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, London, United Kingdom
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Wang YM, Liu CW, Chen SY, Lu LY, Liu WC, Wang JH, Ni CL, Wong SB, Kumar A, Lee JC, Kuo SH, Wu SC, Pan MK. Neuronal population activity in the olivocerebellum encodes the frequency of essential tremor in mice and patients. Sci Transl Med 2024; 16:eadl1408. [PMID: 38748772 DOI: 10.1126/scitranslmed.adl1408] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/24/2024] [Indexed: 05/24/2025]
Abstract
Essential tremor (ET) is the most prevalent movement disorder, characterized primarily by action tremor, an involuntary rhythmic movement with a specific frequency. However, the neuronal mechanism underlying the coding of tremor frequency remains unexplored. Here, we used in vivo electrophysiology, optogenetics, and simultaneous motion tracking in the Grid2dupE3 mouse model to investigate whether and how neuronal activity in the olivocerebellum determines the frequency of essential tremor. We report that tremor frequency was encoded by the temporal coherence of population neuronal firing within the olivocerebellums of these mice, leading to frequency-dependent cerebellar oscillations and tremors. This mechanism was precise and generalizable, enabling us to use optogenetic stimulation of the deep cerebellar nuclei to induce frequency-specific tremors in wild-type mice or alter tremor frequencies in tremor mice. In patients with ET, we showed that deep brain stimulation of the thalamus suppressed tremor symptoms but did not eliminate cerebellar oscillations measured by electroencephalgraphy, indicating that tremor-related oscillations in the cerebellum do not require the reciprocal interactions with the thalamus. Frequency-disrupting transcranial alternating current stimulation of the cerebellum could suppress tremor amplitudes, confirming the frequency modulatory role of the cerebellum in patients with ET. These findings offer a neurodynamic basis for the frequency-dependent stimulation of the cerebellum to treat essential tremor.
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Affiliation(s)
- Yi-Mei Wang
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 632007, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
| | - Chia-Wei Liu
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
| | - Shun-Ying Chen
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei 10638, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan
| | - Liang-Yin Lu
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 632007, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan
| | - Wen-Chuan Liu
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Jia-Huei Wang
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
| | - Chun-Lun Ni
- Initiative for Columbia Ataxia and Tremor, New York, NY 10032, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Shi-Bing Wong
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231016, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970374, Taiwan
| | - Ami Kumar
- Initiative for Columbia Ataxia and Tremor, New York, NY 10032, USA
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Jye-Chang Lee
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan
| | - Sheng-Han Kuo
- Initiative for Columbia Ataxia and Tremor, New York, NY 10032, USA
- Department of Neurology, Columbia University, New York, NY 10032, USA
| | - Shun-Chi Wu
- Department of Engineering and System Science, National Tsing Hua University, Hsinchu 300044, Taiwan
| | - Ming-Kai Pan
- Cerebellar Research Center, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin 632007, Taiwan
- Molecular Imaging Center, National Taiwan University, Taipei 106038, Taiwan
- Department and Graduate Institute of Pharmacology, National Taiwan University College of Medicine, Taipei 100233, Taiwan
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei 10638, Taiwan
- Institute of Biomedical Sciences, Academia Sinica, Taipei 115201, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei 100225, Taiwan
- Initiative for Columbia Ataxia and Tremor, New York, NY 10032, USA
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Slavin KV. Magnetic resonance imaging of radiofrequency thalamotomy for tremor: what is it about? Brain Commun 2024; 6:fcae040. [PMID: 38384999 PMCID: PMC10881052 DOI: 10.1093/braincomms/fcae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 12/31/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
This scientific commentary refers to 'Radiofrequency thalamotomy for tremor produces focused and predictable lesions shown on magnetic resonance images', by Ishihara et al. (https://doi.org/10.1093/braincomms/fcad329).
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Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL 60612, USA
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Eleni Karakatsani M, Estrada H, Chen Z, Shoham S, Deán-Ben XL, Razansky D. Shedding light on ultrasound in action: Optical and optoacoustic monitoring of ultrasound brain interventions. Adv Drug Deliv Rev 2024; 205:115177. [PMID: 38184194 PMCID: PMC11298795 DOI: 10.1016/j.addr.2023.115177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 01/08/2024]
Abstract
Monitoring brain responses to ultrasonic interventions is becoming an important pillar of a growing number of applications employing acoustic waves to actuate and cure the brain. Optical interrogation of living tissues provides a unique means for retrieving functional and molecular information related to brain activity and disease-specific biomarkers. The hybrid optoacoustic imaging methods have further enabled deep-tissue imaging with optical contrast at high spatial and temporal resolution. The marriage between light and sound thus brings together the highly complementary advantages of both modalities toward high precision interrogation, stimulation, and therapy of the brain with strong impact in the fields of ultrasound neuromodulation, gene and drug delivery, or noninvasive treatments of neurological and neurodegenerative disorders. In this review, we elaborate on current advances in optical and optoacoustic monitoring of ultrasound interventions. We describe the main principles and mechanisms underlying each method before diving into the corresponding biomedical applications. We identify areas of improvement as well as promising approaches with clinical translation potential.
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Affiliation(s)
- Maria Eleni Karakatsani
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Héctor Estrada
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Zhenyue Chen
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland
| | - Shy Shoham
- Department of Ophthalmology and Tech4Health and Neuroscience Institutes, NYU Langone Health, NY, USA
| | - Xosé Luís Deán-Ben
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland.
| | - Daniel Razansky
- Institute for Biomedical Engineering and Institute of Pharmacology and Toxicology, Faculty of Medicine, University of Zurich, Switzerland; Institute for Biomedical Engineering, Department of Information Technology and Electrical Engineering, ETH Zurich, Switzerland.
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Kim C, Eames M, Paeng DG. Improving Sonication Efficiency in Transcranial MR-Guided Focused Ultrasound Treatment: A Patient-Data Simulation Study. Bioengineering (Basel) 2023; 11:27. [PMID: 38247904 PMCID: PMC10813010 DOI: 10.3390/bioengineering11010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
The potential improvement in sonication efficiency achieved by tilting the focused ultrasound (FUS) transducer of the transcranial MR-guided FUS system is presented. A total of 56 cases of patient treatment data were used. The relative position of the clinical FUS transducer to the patient's head was reconstructed, and region-specific skull density and porosity were calculated based on the patient's CT volume image. The total transmission coefficient of acoustic waves emitted from each channel was calculated. Then, the total energy penetrating the human skull-which represents the sonication efficiency-was estimated. As a result, improved sonication efficiency was by titling the FUS transducer to a more appropriate angle achieved in all 56 treatment cases. This simulation result suggests the potential improvement in transcranial-focused ultrasound treatment by simply adjusting the transducer angle.
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Affiliation(s)
- Changsoo Kim
- Research Institute for Basic Sciences, Jeju National University, Jeju 63243, Republic of Korea;
| | - Matthew Eames
- Focused Ultrasound Foundation, Charlottesville, VA 22903, USA;
- Department of Radiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Dong-Guk Paeng
- Focused Ultrasound Foundation, Charlottesville, VA 22903, USA;
- Ocean System Engineering, Jeju National University, Jeju 63243, Republic of Korea
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11
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Guehl D, Guillaud E, Langbour N, Doat E, Auzou N, Courtin E, Branchard O, Engelhardt J, Benazzouz A, Eusebio A, Cuny E, Burbaud P. Usefulness of thalamic beta activity for closed-loop therapy in essential tremor. Sci Rep 2023; 13:22332. [PMID: 38102180 PMCID: PMC10724233 DOI: 10.1038/s41598-023-49511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
A partial loss of effectiveness of deep brain stimulation of the ventral intermediate nucleus of the thalamus (VIM) has been reported in some patients with essential tremor (ET), possibly due to habituation to permanent stimulation. This study focused on the evolution of VIM local-field potentials (LFPs) data over time to assess the long-term feasibility of closed-loop therapy based on thalamic activity. We performed recordings of thalamic LFPs in 10 patients with severe ET using the ACTIVA™ PC + S (Medtronic plc.) allowing both recordings and stimulation in the same region. Particular attention was paid to describing the evolution of LFPs over time from 3 to 24 months after surgery when the stimulation was Off. We demonstrated a significant decrease in high-beta LFPs amplitude during movements inducing tremor in comparison to the rest condition 3 months after surgery (1.91 ± 0.89 at rest vs. 1.27 ± 1.37 µV2/Hz during posture/action for N = 8/10 patients; p = 0.010), 12 months after surgery (2.92 ± 1.75 at rest vs. 2.12 ± 1.78 µV2/Hz during posture/action for N = 7/10 patients; p = 0.014) and 24 months after surgery (2.32 ± 0.35 at rest vs 0.75 ± 0.78 µV2/Hz during posture/action for 4/6 patients; p = 0.017). Among the patients who exhibited a significant decrease of high-beta LFP amplitude when stimulation was Off, this phenomenon was observed at least twice during the follow-up. Although the extent of this decrease in high-beta LFPs amplitude during movements inducing tremor may vary over time, this thalamic biomarker of movement could potentially be usable for closed-loop therapy in the long term.
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Affiliation(s)
- Dominique Guehl
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France.
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France.
| | - Etienne Guillaud
- Institute of Cognitive and Integrative Neurosciences, Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | - Nicolas Langbour
- Centre de Recherche en Psychiatrie, CH de la Milétrie, 86000, Poitiers, France
| | - Emilie Doat
- Institute of Cognitive and Integrative Neurosciences, Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | - Nicolas Auzou
- Institut des Maladies Neurodégénératives Clinique (IMNc), Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | - Edouard Courtin
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | | | | | - Abdelhamid Benazzouz
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, APHM, Hôpitaux Universitaire de Marseille, Marseille, France
- Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Univ, CNRS, Marseille, France
| | - Emmanuel Cuny
- Service de Neurochirurgie, CHU de Bordeaux, Bordeaux, France
| | - Pierre Burbaud
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France
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12
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Ishihara BK, Hart MG, Barrick TR, Howe FA, Morgante F, Pereira EA. Radiofrequency thalamotomy for tremor produces focused and predictable lesions shown on magnetic resonance images. Brain Commun 2023; 5:fcad329. [PMID: 38075945 PMCID: PMC10710300 DOI: 10.1093/braincomms/fcad329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/06/2023] [Accepted: 11/28/2023] [Indexed: 02/23/2024] Open
Abstract
Radiofrequency thalamotomy is a neurosurgical management option for medically-refractory tremor. In this observational study, we evaluate the MRI features of the resultant lesion, their temporal dynamics, and how they vary depending on surgical factors. We report on lesion characteristics including size and location, as well as how these vary over time and across different MRI sequences. Data from 12 patients (2 essential tremor, 10 Parkinson's disease) who underwent unilateral radiofrequency thalamotomy for tremor were analysed. Lesion characteristics were compared across five structural sequences. Volumetric analysis of lesion features was performed at early (<5 weeks) and late (>5 months) timepoints by manual segmentation. Lesion location was determined after registration of lesions to standard space. All patients showed tremor improvement (clinical global impressions scale) postoperatively. Chronic side-effects included balance disturbances (n = 4) and worsening mobility due to parkinsonism progression (n = 1). Early lesion features including a necrotic core, cytotoxic oedema and perilesional oedema were best demarcated on T2-weighted sequences. Multiple lesions were associated with greater cytotoxic oedema compared with single lesions (T2-weighted mean volume: 537 ± 112 mm³ versus 302 ± 146 mm³, P = 0.028). Total lesion volume reduced on average by 90% between the early and late scans (T2-weighted mean volume: 918 ± 517 versus 75 ± 50 mm³, t = 3.592, P = 0.023, n = 5), with comparable volumes demonstrated at ∼6 months after surgery. Lesion volumes on susceptibility-weighted images were larger than those of T2-weighted images at later timepoints. Radiofrequency thalamotomy produces focused and predictable lesion imaging characteristics over time. T2-weighted scans distinguish between the early lesion core and oedema characteristics, while lesions may remain more visible on susceptibility-weighted images in the months following surgery. Scanning patients in the immediate postoperative period and then at 6 months is clinically meaningful for understanding the anatomical basis of the transient and permanent effects of thalamotomy.
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Affiliation(s)
- Bryony K Ishihara
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Michael G Hart
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Thomas R Barrick
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Franklyn A Howe
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
- Department of Experimental and Clinical Medicine, University of Messina, 98122 Messina, Italy
| | - Erlick A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
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13
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Song G, Plumlee P, Ahn JY, Wong ST, Zhao H. Translational strategies and systems biology insights for blood-brain barrier opening and delivery in brain tumors and Alzheimer's disease. Biomed Pharmacother 2023; 167:115450. [PMID: 37703663 PMCID: PMC10591819 DOI: 10.1016/j.biopha.2023.115450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023] Open
Abstract
The blood-brain barrier (BBB) plays a critical role in determining the effectiveness of systemic treatments for brain diseases. Over the years, several innovative approaches in BBB opening and drug delivery have been developed and progressed into clinical testing phases, including focused ultrasound (FUS) with circulating microbubbles, mannitol-facilitated delivery of anti-neoplastic drugs, receptor-mediated transcytosis (RMT) by antibody-drug conjugates (ADCs), and viral vectors for gene therapy. We provided a comprehensive review of the most recent clinical applications of these approaches in managing brain tumors and Alzheimer's disease (AD), two major devastating brain diseases. Moreover, the spatial-temporal molecular heterogeneity of the BBB under disease states emphasized the importance of utilizing emerging spatial systems biology approaches to unravel novel targets for intervention within BBB and tailor strategies for enhancing drug delivery to the brain. SEARCH STRATEGY AND SELECTION CRITERIA: Data for this Review were identified by searches of clinicaltrials.gov, MEDLINE, Current Contents, PubMed, and references from relevant articles using the search terms "blood-brain barrier", "CNS drug delivery", "BBB modulation", "clinical trials", "systems biology", "primary or metastatic brain tumors", "Alzheimer's disease". Abstracts and reports from meetings were included only when they related directly to previously published work. Only articles published in English between 1980 and 2023 were included.
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Affiliation(s)
- Gefei Song
- T. T. and W. F. Chao Center for BRAIN and Department of Systems Medicine and Bioengineering, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston TX 77030, USA
| | - Pierce Plumlee
- T. T. and W. F. Chao Center for BRAIN and Department of Systems Medicine and Bioengineering, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston TX 77030, USA
| | - Ju Young Ahn
- T. T. and W. F. Chao Center for BRAIN and Department of Systems Medicine and Bioengineering, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston TX 77030, USA; Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Stephen Tc Wong
- T. T. and W. F. Chao Center for BRAIN and Department of Systems Medicine and Bioengineering, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston TX 77030, USA; Department of Biomedical Engineering, Texas A&M University, College Station, TX 77843, USA.
| | - Hong Zhao
- T. T. and W. F. Chao Center for BRAIN and Department of Systems Medicine and Bioengineering, Houston Methodist Neal Cancer Center, Houston Methodist Hospital, Houston TX 77030, USA.
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14
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Reddy A, Hosseini MR, Patel A, Sharaf R, Reddy V, Tabarestani A, Lucke-Wold B. Deep brain stimulation, lesioning, focused ultrasound: update on utility. AIMS Neurosci 2023; 10:87-108. [PMID: 37426775 PMCID: PMC10323264 DOI: 10.3934/neuroscience.2023007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 06/18/2023] Open
Abstract
Procedures for neurological disorders such as Parkinsons Disease (PD), Essential Tremor (ET), Obsessive Compulsive Disorder (OCD), Tourette's Syndrome (TS), and Major Depressive Disorder (MDD) tend to overlap. Common therapeutic procedures include deep brain stimulation (DBS), lesioning, and focused ultrasound (FUS). There has been significant change and innovation regarding targeting mechanisms and new advancements in this field allowing for better clinical outcomes in patients with severe cases of these conditions. In this review, we discuss advancements and recent discoveries regarding these three procedures and how they have led to changes in utilization in certain conditions. We further discuss the advantages and drawbacks of these treatments in certain conditions and the emerging advancements in brain-computer interface (BCI) and its utility as a therapeutic for neurological disorders.
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Affiliation(s)
| | | | | | - Ramy Sharaf
- College of Medicine, University of Florida, USA
| | - Vishruth Reddy
- Feinberg School of Medicine, Northwestern University, USA
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15
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Pirker W, Katzenschlager R, Hallett M, Poewe W. Pharmacological Treatment of Tremor in Parkinson's Disease Revisited. JOURNAL OF PARKINSON'S DISEASE 2023; 13:127-144. [PMID: 36847017 PMCID: PMC10041452 DOI: 10.3233/jpd-225060] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The pathophysiology of Parkinson's disease (PD) tremor remains incompletely understood and there is a lack of clinical trials specifically addressing its pharmacological treatment. Levodopa is the most efficacious drug for most patients and should be used as primary approach to control troublesome tremor. While the efficacy of oral dopamine agonists on PD tremor has been demonstrated in controlled trials, there is no evidence of greater antitremor efficacy compared to levodopa. The magnitude of the antitremor effect of anticholinergics is generally lower than that of levodopa. Due to their adverse effects, anticholinergics have a limited role in selected young and cognitively intact patients. Propranolol may improve resting and action tremor and may be considered as an adjunct in patients with insufficient tremor response to levodopa and this also applies to clozapine, despite its unfavorable adverse effect profile. Treating motor fluctuations with MAO-B and COMT inhibitors, dopamine agonists, amantadine, or on-demand treatments such as subcutaneous or sublingual apomorphine and inhaled levodopa as well as with continuous infusions of levodopa or apomorphine will improve off period tremor episodes. For patients with drug-refractory PD tremor despite levodopa optimization deep brain stimulation and focused ultrasound are first-line considerations. Surgery can also be highly effective for the treatment medication-refractory tremor in selected patients without motor fluctuations. The present review highlights the clinical essentials of parkinsonian tremor, critically examines available trial data on the effects of medication and surgical approaches and provides guidance for the choice of treatments to control PD tremor in clinical practice.
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Affiliation(s)
- Walter Pirker
- Department of Neurology, Klinik Ottakring, Vienna, Austria
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Klinik Donaustadt, Vienna, Austria
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Werner Poewe
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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16
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Truong D, Shaikh A, Hallett M. Editorial: Tremors. J Neurol Sci 2022; 435:120189. [PMID: 35272092 DOI: 10.1016/j.jns.2022.120189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Daniel Truong
- Department of Psychiatry and Neuroscience, University of California Riverside, Riverside, CA, USA; The Truong Neurosciences Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA, USA.
| | - Aasef Shaikh
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA; Neurology Service, Louis Stokes Cleveland VA Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
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