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Neurology. 2018 Oct 2;91(14):e1275-e1284. doi: 10.1212/WNL.0000000000006279. Epub 2018 Aug 29.

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

Author information

1
From the Departments of Neurology (S.A.S., B.B.S., M.J.B.), Neurosurgery (A.E.B., W.J.E.), and Physical Therapy (D.S.H.), University of Virginia Health Science Center, Charlottesville; and College of Arts and Sciences (J.A.G.M.), University of Virginia, Charlottesville. sas7yr@virginia.edu.
2
From the Departments of Neurology (S.A.S., B.B.S., M.J.B.), Neurosurgery (A.E.B., W.J.E.), and Physical Therapy (D.S.H.), University of Virginia Health Science Center, Charlottesville; and College of Arts and Sciences (J.A.G.M.), University of Virginia, Charlottesville.

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.

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