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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.
Glossary
- ADL=
- activities of daily living;
- BDI-II=
- Beck Depression Inventory–Second Edition;
- CRST=
- Clinical Rating Scale for Tremor;
- DBS=
- deep brain stimulation;
- FrSBe=
- Frontal Systems Behavior Scale;
- MRIgFUS=
- MRI-guided focused ultrasound;
- PD=
- Parkinson disease;
- PDQ-39=
- 39-item Parkinson's Disease Questionnaire;
- QoL=
- quality of life;
- TDPD=
- tremor-dominant Parkinson disease;
- UPDRS=
- Unified Parkinson's Disease Rating Scale;
- Vim=
- ventral intermediate nucleus;
- WCST-64=
- Wisconsin Card Sorting Test–64
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Editorial page 641
Class of Evidence: NPub.org/coe
- Received January 23, 2018.
- Accepted in final form June 14, 2018.
- © 2018 American Academy of Neurology
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