Aviles-Olmos, I. (Iciar)
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- Magnetic resonance-guided focused ultrasound (MRgFUS)-Thalamotomy for essential tremor: lesion location and clinical outcomes(Wiley, 2024) Arcadi, A. (Alana); Gorospe, A. (Arantza); Jiménez-Huete, A. (Adolfo); González-Quarante, L.H. (Lain Hermes); Martín-Bastida, A. (Antonio); Aviles-Olmos, I. (Iciar); Guridi, J. (Jorge); Macías-de-la-Corte, M. (Marta); Rodriguez-Oroz, M.C. (María Cruz); Riverol, M. (Mario); Villino, R. (Rafael); Parras, O. (Olga)Background: Factors predicting clinical outcomes after MR-guided focused ultrasound (MRgFUS)-thalamotomy in patients with essential tremor (ET) are not well known. Objective: To examine the clinical outcomes and their relationship with patients’ baseline demographic and clinical features and lesion characteristics at 6-month follow-up in ET patients. Methods: A total of 127 patients were prospectively evaluated at 1 (n = 122), 3 (n = 102), and 6 months (n = 78) after MRgFUS-thalamotomy. Magnetic resonance imaging (MRI) was obtained at 6 months (n = 60). Primary outcomes included: (1) change in the Clinical Rating Scale of Tremor (CRST)-A+B score in the treated hand and (2) frequency and severity of adverse events (AEs) at 6 months. Secondary outcomes included changes in all subitems of the CRST scale in the treated hand, CRST-C, axial tremor (face, head, voice, tongue), AEs, and correlation of primary outcomes at 6 months with lesion characteristics. Statistical analysis included linear mixed, standard, and logistic regression models. Results: Scores for CRST-A+B, CRST-A, CRST-B in the treated hand, CRST-C, and axial tremor were improved at each evaluation (P < 0.001). Five patients had severe AEs at 1 month that became mild throughout the follow-up. Mild AEs occurred in 71%, 45%, and 34% of patients at 1, 3, and 6 months, respectively. Lesion volume was associated with the reduction in the CRST-A (P = 0.003) and its overlapping with the ventralis intermedius nucleus (Vim) nucleus with the reduction in CRST-A+B (P = 0.02) and CRST-B (P = 0.008) at 6 months. Conclusions: MRgFUS-thalamotomy improves hand and axial tremor in ET patients. Transient and mild AEs are frequent. Lesion volume and location are associated with tremor reduction. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
- Towards an adiposity-related disease framework for the diagnosis and management of obesities(Springer, 2023) Perdomo-Zelaya, C.M. (Carolina M.); Frühbeck, G. (Gema); Aviles-Olmos, I. (Iciar); Dicker, D. (Dror)Obesity is a complex disease that relapses frequently and associates with multiple complications that comprise a worldwide health priority because of its rising prevalence and association with numerous complications, including metabolic disorders, mechanic pathologies, and cancer, among others. Noteworthy, excess adiposity is accompanied by chronic inflammation, oxidative stress, insulin resistance, and subsequent organ dysfunction. This dysfunctional adipose tissue is initially stored in the visceral depot, overflowing subsequently to produce lipotoxicity in ectopic depots like liver, heart, muscle, and pancreas, among others. People living with obesity need a diagnostic approach that considers an exhaustive pathophysiology and complications assessment. Thus, it is essential to warrant a holistic diagnosis and management that guarantees an adequate health status, and quality of life. The present review summarizes the different complications associated with obesity, at the same time, we aim to fostering a novel framework that enhances a patient-centered approach to obesity management in the precision medicine era.
- Agrypnia Excitata and Supranuclear Vertical Gaze Palsy Linked to Anti-Ma Encephalitis(Wiley Periodicals LLC, 2024) Arbizu, J. (Javier); Espinoza-Vinces, C. (Christian); Horrillo-Maysonnial, A. (Alejandro); Aviles-Olmos, I. (Iciar); Calvo-Imirizaldu, M. (Marta); Pérez-Álvarez, A.I (Ángel Ignacio); Urrestarazu, E. (Elena); Gallego-Perez-Larraya, J. (Jaime)Paraneoplastic neurological syndromes result from cancer’s immune impact on the nervous system.1 Anti-Ma-associated encephalitis causes diencephalic, brainstem, and limbic symptoms such as memory loss, narcolepsy and rapid eye movement (REM) behavior disorder (RBD), eye movement abnormalities, and parkinsonism. It can precede cancer diagnosis, often linked to testicular tumors. Agrypnia excitata (AE) is a unique electroclinical syndrome that can disrupt sleep structure with changes in physiological cyclic organization, autonomic overactivity, and oneiric stupor episodes. We report on a patient with anti-Ma encephalitis who exhibits a diencephalic syndrome and AE, not previously reported to our knowledge.
- Short and long term outcome of bilateral pallidal stimulation in chorea-acanthocytosis(Public Library of Science, 2013) Cho, J.W. (Jin Whan); Miquel, M. (Marie); Shin, H. (Hyeeun); Kefalopoulou, Z.M. (Zinovia Maria); Jarman, P. (Paul); Danek, A. (Adrian); Guridi-Legarra, J. (Jorge); Hariz, M. (Marwan); Bertram, K. (Kelly); Zrinzo, L. (Ludvic); Guehl, D. (Dominique); Lozano, A.M. (Andres M.); Bhatia, K. (Kailash); Gimenez-Roldan, S. (Santiago); Limousin, P. (Patricia); Garcia-Ruiz, P.J. (Pedro J.); Walker, R.H. (Ruth H.); Aviles-Olmos, I. (Iciar); Bader, B. (Benedikt); Moro, E. (Elena); Yokochi, F. (Fusako); Burghaus, L. (Lothar); Rodriguez-Oroz, M.C. (María Cruz); Latxague, C. (Chrystelle); Lipsman, N. (Nir); Burbaud, P. (Pierre); Shang, H. (Huifang); Cuny, E. (Emmanuel); Tison, F. (François); Foltynie, T. (Thomas); Spampinato, U. (Umberto); Ngy, D. (Dhita)BACKGROUND: Chorea-acanthocytosis (ChAc) is a neuroacanthocytosis syndrome presenting with severe movement disorders poorly responsive to drug therapy. Case reports suggest that bilateral deep brain stimulation (DBS) of the ventro-postero-lateral internal globus pallidus (GPi) may benefit these patients. To explore this issue, the present multicentre (n=12) retrospective study collected the short and long term outcome of 15 patients who underwent DBS. METHODS: Data were collected in a standardized way 2-6 months preoperatively, 1-5 months (early) and 6 months or more (late) after surgery at the last follow-up visit (mean follow-up: 29.5 months). RESULTS: Motor severity, assessed by the Unified Huntington's Disease Rating Scale-Motor Score, UHDRS-MS), was significantly reduced at both early and late post-surgery time points (mean improvement 54.3% and 44.1%, respectively). Functional capacity (UHDRS-Functional Capacity Score) was also significantly improved at both post-surgery time points (mean 75.5% and 73.3%, respectively), whereas incapacity (UHDRS-Independence Score) improvement reached significance at early post-surgery only (mean 37.3%). Long term significant improvement of motor symptom severity (≥ 20 % from baseline) was observed in 61.5 % of the patients. Chorea and dystonia improved, whereas effects on dysarthria and swallowing were variable. Parkinsonism did not improve. Linear regression analysis showed that preoperative motor severity predicted motor improvement at both post-surgery time points. The most serious adverse event was device infection and cerebral abscess, and one patient died suddenly of unclear cause, 4 years after surgery. CONCLUSION: This study shows that bilateral DBS of the GPi effectively reduces the severity of drug-resistant hyperkinetic movement disorders such as present in ChAc.
- El correo electrónico en la consulta de Parkinson: ¿soluciones a un clic?(Elsevier, 2018) Estévez-Fraga, C. (C.); Sánchez-Díez, G. (G.); García-Ribas, G. (G.); Masjuan-Vallejo, J. (J.); Martínez-Castrillo, J.C. (J. C.); Alonso-Cánovas, A. (A.); Aviles-Olmos, I. (Iciar); Crespo-Araico, L. (L.); Agüero, P. (P.); Viedma-Guiard, E. (E.); López-Sendón, J.L. (J. L.); Palacios-Romero, M.L. (M. L.)Introducción: La problemática de los trastornos del movimiento (TM) es compleja y la duración y frecuencia de las consultas presenciales puede estar limitada por problemas de espacio y tiempo. Analizamos el funcionamiento de un servicio de atención por correo electrónico institucional para médicos de Atención Primaria (MAP) y pacientes en la Unidad de Trastornos del Movimiento (UTM). Métodos: Se revisaron retrospectivamente los correos electrónicos enviados y recibidos en un periodo de 4 meses, un ano˜ tras su implantación. La dirección se proporcionaba en consulta y mediante sesiones informativas a los MAP del área. Se analizaron datos clínicos y demográficos de los pacientes, tipo de interlocutor, número de consultas, motivo y actuaciones derivadas de ellas. Resultados: Del 1 de enero al 30 de abril de 2015 se recibieron 137 correos de 63 pacientes (43% varones; edad 71 ± 10,5 anos) ˜ diagnosticados de enfermedad de Parkinson (76%), parkinsonismos atípicos (10%) y otros (14%), y se enviaron 116 respuestas. En 20 casos (32%) fueron redactados por el paciente, en 38 (60%) por sus familiares y en 5 (8%) por MAP. Los motivos de consulta fueron clínicos en 50 casos (80%): deterioro clínico (16; 32%), nuevos síntomas (14; 28%), efectos secundarios o dudas sobre medicación (20; 40%). Como consecuencia, se adelantó una cita programada en 9 casos (14%), mientras que el resto se solucionaron por correo electrónico. En 13 (20%), el motivo de consulta fue burocrático: relacionado con citas (11, 85%) y solicitud de informe (2, 15%). La satisfacción fue generalizada, sin constituir una sobrecarga asistencial excesiva para los facultativos responsables.
- Factors associated with headache and nausea during magnetic resonance–guided focused ultrasound for tremor(Wiley, 2021) Cacho-Asenjo, E. (Elena); Honorato-Cía, C. (Cristina); Nuñez-Cordoba, J.M. (Jorge M.); Fernández-Martínez, M. (Miguel); González-Quarante, L.H. (Lain Hermes); Aviles-Olmos, I. (Iciar); Gorospe, A. (Arantza); Panadero-Sánchez, A. (Alfredo); Rodríguez-Oroz, M. (María Cruz); Guridi, J. (Jorge); Martínez-Simón, A. (Antonio)Background: During magnetic resonance–guided focused ultrasound for essential or parkinsoniantremor, adverse events (headache, nausea/vomiting, or anxiety) may alter the outcome of the proceduredespite being mostly transient and mild.ObjectivesObjectives: Our aim was to analyze the relationship between demographic, procedural, and anestheticcharacteristics with magnetic resonance/ultrasound-related events.MethodsMethods: This was a retrospective study at the Clinica Universidad de Navarra of patients undergoingthalamotomy with magnetic resonance–guided focused ultrasound between September 2018 and October2019. The anesthesia protocol included headache and nausea/vomiting prophylaxis and rescue therapy.Dexmedetomidine was used for anxiolysis in some patients after thorough multidisciplinary assessment.ResultsResults: A total of 123 patients were included. Headache was directly related to skull density ratio (P < 0.001)and skull thickness (P = 0.02). Patients with a skull density ratio less than 0.48 had 3 times the odds ofexperiencing moderate or severe headache (odds ratio [OR], 3.08; 95% confidence interval [CI], 1.21–7.82) andhad a higher odds of aborting sonication due to pain. Sex was associated with increased nausea (P = 0.007).Women had 4 times the odds of nausea than men (OR, 4.4; 95% CI, 1.61–12.11). Dexmedetomidine did not reduceheadache or nausea incidence. Patients who received dexmedetomidine had a higher number (P = 0.01) andtotal minutes of sonication (P = 0.01).ConclusionsConclusions: Patients with lower skull density ratios and higher skull thicknesses could benefit from an aggressiveanalgesic prophylaxis. Women are more likely to experience nausea. Dexmedetomidine did not reduce headacheand nausea, but increased the number and duration of sonications. Its exact effect on tremor is still unclear.
- 3-T MR-guided focused ultrasound thalamotomy for tremor in patients with a cardiac pacemaker: case series and review of the literature(AANS, 2024) González-Quarante, L.H. (Lain Hermes); Gonzalez-Crespo, A. (Antonio); Arcadi, A. (Alana); Macías-de-la-Corte, M. (Marta); Aviles-Olmos, I. (Iciar); Sanchez-Catasus, C.A. (Carlos A.); Cacho-Asenjo, E. (Elena); Honorato-Cía, C. (Cristina); Martinez-Simon, A. (Antonio); Gorospe, A. (Arantza); Martín-Bastida, A. (Antonio); Corral, P. (Paula); Rodriguez-Oroz, M.C. (María Cruz); Guridi, J. (Jorge)MR-guided focused ultrasound (MRgFUS) has proven its efficacy and safety for the treatment of essential tremor (ET) and/or Parkinson’s disease (PD). However, having a cardiac pacemaker has been considered an exclusion criterion for the use of MRgFUS. Only 2 patients with a cardiac pacemaker treated with MRgFUS have been previously reported, both treated using 1.5-T MRI. In this paper, the authors present their experience performing 3-T MRgFUS thalamotomy in 4 patients with an implanted cardiac pacemaker. Treatments were uneventful regarding complications or severe side effects. MRgFUS using 3-T MRI was found to be an efficient and safe treatment for ET and/or PD in patients with an MRI-compatible pacemaker.
- Unilateral Magnetic Resonance-Guided Focused Ultrasound Lesion of the Subthalamic Nucleus in Parkinson's Disease: A Prospective Study(Wiley, 2024) Armengou-Garcia, L. (Laura); Sanchez-Catasus, C.A. (Carlos A.); Aviles-Olmos, I. (Iciar); Jiménez-Huete, A. (Adolfo); Montoya-Murillo, G. (Genoveva); Gorospe, A. (Arantza); Martín-Bastida, A. (Antonio); González-Quarante, L.H. (Lain Hermes); Guridi, J. (Jorge); Rodriguez-Oroz, M.C. (María Cruz)Background: Unilateral subthalamic nucleus (STN) ablation using magnetic resonance-guided focused ultrasound (MRgFUS) is being explored as a new treatment for asymmetric Parkinson's disease (PD). Objectives: The aims were to study the efficacy and safety of this treatment in asymmetric PD patients and to characterize the lesions. Methods: This prospective, single-center, open-label study evaluated asymmetric PD patients at 6 (n = 20) and 12 months (n = 12) after MRgFUS lesion of the STN. The primary outcome was the change in the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Part III (MDS-UPDRS III), score in off medication on the treated side and the adverse events (AEs) at 6-month follow-up. We also evaluated cognitive-neuropsychological changes, self-assessment of clinical improvement, and the correlation of the lesion volume with the motor outcomes. Results: On the treated side, the MDS-UPDRS III score (mean difference = 13.8) and the scores in rigidity, bradykinesia, and tremor improved (P < 0.001) throughout the follow-up compared to baseline (at 6 months: rigidity mean difference = 2.8, improvement: 83.5%; bradykinesia mean difference = 6.0, improvement: 69.4%; tremor mean difference = 4.7, improvement: 91.5%). One patient had severe weakness in the treated hemibody, 1 had moderate dyskinesia, and 1 was in moderate confusional state that became mild (weakness) or completely resolved (dyskinesia and confusional state) at 6 months. The rest of the AEs were mild. We observed no clinically relevant changes in cognitive-neuropsychological tests. The percentage of ablation of the STN correlated with the improvement in the total MDS-UPDRS III and contralateral tremor scores (P < 0.05). Conclusion: Unilateral MRgFUS lesion of the STN resulted in a significant motor improvement. We observed no persistent severe AEs, although mild, mostly transient AEs were frequent. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.