Functional Neurosurgery for Parkinson’s Disease

✓ Irving S. Cooper (1922–1985), the son of a salesman, worked his way through high school, college, and medical school to become one of the pioneers in functional neurosurgery. He developed several novel techniques for the surgical management of Parkinson's disease and other crippling movement disorders. A keen interest in the physiology of movement disorders was kindled by his doctoral research and continued during his neurosurgical training. He began to apply this knowledge to surgical practice in 1952 when he began his faculty career as Assistant Professor of Surgery at New York University. At the time, surgical treatment of parkinsonian tremor focused on various techniques used to interrupt the pyramidal tract. During a subtemporal approach for a cerebral pedunculotomy, he inadvertently injured and, subsequently, was forced to occlude the anterior choroidal artery. Much to Cooper's surprise, following emergence from anesthesia the patient's tremor and rigidity were abolished without any residual hemiparesis. This serendipitous observation, together with Meyer's earlier work on the role of the basal ganglia in motor control, helped focus surgical efforts on targets within the basal ganglia and, subsequently, within the thalamus to alleviate the movement disorders associated with Parkinson's disease. While at New York University, Cooper developed chemopallidectomy and, later at St. Barnabas Hospital in the Bronx (1954–1977), he used cryothalamectomy as a surgical technique for primary control of tremor in patients with Parkinson's disease. Cooper authored many original papers on surgical techniques and several textbooks on the lives of patients afflicted with Parkinson's disease and other crippling movement disorders. Although considered controversial, this fascinating and complex neurosurgeon made significant contributions to this field.

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Consensus Statement on High-Intensity Focused Ultrasound for Functional Neurosurgery in Switzerland

Frontiers in Neurology ◽

10.3389/fneur.2021.722762 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lennart H. Stieglitz ◽

Markus F. Oertel ◽

Ettore A. Accolla ◽

Julien Bally ◽

Roland Bauer ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Patient Selection ◽

Movement Disorders ◽

High Intensity ◽

Focused Ultrasound ◽

High Intensity Focused Ultrasound ◽

Brain Disorders ◽

Functional Neurosurgery ◽

Consensus Paper

Background: Magnetic resonance-guided high-intensity focused ultrasound (MRgHiFUS) has evolved into a viable ablative treatment option for functional neurosurgery. However, it is not clear yet, how this new technology should be integrated into current and established clinical practice and a consensus should be found about recommended indications, stereotactic targets, patient selection, and outcome measurements.Objective: To sum up and unify current knowledge and clinical experience of Swiss neurological and neurosurgical communities regarding MRgHiFUS interventions for brain disorders to be published as a national consensus paper.Methods: Eighteen experienced neurosurgeons and neurologists practicing in Switzerland in the field of movement disorders and one health physicist representing 15 departments of 12 Swiss clinical centers and 5 medical societies participated in the workshop and contributed to the consensus paper. All experts have experience with current treatment modalities or with MRgHiFUS. They were invited to participate in two workshops and consensus meetings and one online meeting. As part of workshop preparations, a thorough literature review was undertaken and distributed among participants together with a list of relevant discussion topics. Special emphasis was put on current experience and practice, and areas of controversy regarding clinical application of MRgHiFUS for functional neurosurgery.Results: The recommendations addressed lesioning for treatment of brain disorders in general, and with respect to MRgHiFUS indications, stereotactic targets, treatment alternatives, patient selection and management, standardization of reporting and follow-up, and initialization of a national registry for interventional therapies of movement disorders. Good clinical evidence is presently only available for unilateral thalamic lesioning in treating essential tremor or tremor-dominant Parkinson's disease and, to a minor extent, for unilateral subthalamotomy for Parkinson's disease motor features. However, the workgroup unequivocally recommends further exploration and adaptation of MRgHiFUS-based functional lesioning interventions and confirms the need for outcome-based evaluation of these approaches based on a unified registry. MRgHiFUS and DBS should be evaluated by experts familiar with both methods, as they are mutually complementing therapy options to be appreciated for their distinct advantages and potential.Conclusion: This multidisciplinary consensus paper is a representative current recommendation for safe implementation and standardized practice of MRgHiFUS treatments for functional neurosurgery in Switzerland.

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Assessing Preoperative Hope and Expectations Related to Functional Neurosurgery: A New Questionnaire

10.21203/rs.3.rs-558755/v1 ◽

2021 ◽

Author(s):

Michalina Radomska ◽

Joao Flores Alves dos Santos ◽

Kerstin Weber ◽

Marc Baertschi ◽

Pierre R. Burkhard ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Well Being ◽

Temporal Lobectomy ◽

Actual State ◽

Functional Neurosurgery ◽

Everyday Functioning ◽

Cognitive Representations ◽

Surgery Outcomes ◽

Concrete Representations

Abstract Background: Despite successful functional neurosurgery, patients suffering from epilepsy or Parkinson’s disease may experience postoperative psychological distress and social maladjustments. Difficulties in coping with postoperative changes, even positive ones, have shown to be related to patients’ presurgery cognitive representations (i.e., expectations, hope, abstract vs. concrete representations). The aim of this study was to develop an instrument assessing various key features of surgery outcomes’ representations, namely the Preoperative Hope and Expectations Questionnaire, PHEQ. Methods: Participants were patients (n = 50) diagnosed with Parkinson’s disease (n = 25) or epilepsy (n = 25), candidates for functional neurosurgery (i.e., Deep brain stimulation, anterior temporal lobectomy). At 2-3 weeks before the planned surgery, they were administrated items assessing their actual state, preoperative expectations, and hope regarding surgery outcomes. They also completed measures assessing optimism, quality of life and mood. Results: Exploratory analysis resulted in a 16-item version of the PHEQ composed of two factors (abstract representations, including psychological well-being and concrete representations, such as functional aspects of everyday functioning). The PHEQ demonstrated high internal consistency and good convergent validity. Patients were more prone to express postoperative improvements in terms of hope rather than expectations. They generally focused on concrete rather than abstract features, although patients with Parkinson’s disease had higher abstract future-oriented representations. Conclusions: The PHEQ presents satisfactory psychometric properties and may be considered as a reliable instrument for research and clinical practice.

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Phase-dependent suppression of beta oscillations in Parkinson’s disease patients

10.1101/372599 ◽

2018 ◽

Cited By ~ 2

Author(s):

Abbey B. Holt ◽

Eszter Kormann ◽

Alessandro Gulberti ◽

Monika Pötter-Nerger ◽

Colin G. McNamara ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Time Course ◽

Computational Modelling ◽

Brain Diseases ◽

Functional Neurosurgery ◽

Selective Targeting ◽

Beta Frequency ◽

Normal Processing ◽

Specific Phase

AbstractSynchronized oscillations within and between brain areas facilitate normal processing, but are often amplified in disease. A prominent example is the abnormally sustained beta-frequency (~20Hz) oscillations recorded from the cortex and subthalamic nucleus of Parkinson’s Disease patients. Computational modelling suggests that the amplitude of such oscillations could be modulated by applying stimulation at a specific phase. Such a strategy would allow selective targeting of the oscillation, with relatively little effect on other activity parameters. Here we demonstrate in awake, parkinsonian patients undergoing functional neurosurgery, that electrical stimulation arriving on consecutive cycles of a specific phase of the subthalamic oscillation can suppress its amplitude and coupling to cortex. Stimulus-evoked changes in spiking did not have a consistent time course, suggesting that the oscillation was modulated independently of net output. Phase-dependent stimulation could thus be a valuable strategy for treating brain diseases and probing the function of oscillations in the healthy brain.

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