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

      systematic-review

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          Abstract

          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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          Most cited references43

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          How to use the nominal group and Delphi techniques

          Introduction The Nominal Group Technique (NGT) and Delphi Technique are consensus methods used in research that is directed at problem-solving, idea-generation, or determining priorities. While consensus methods are commonly used in health services literature, few studies in pharmacy practice use these methods. This paper provides an overview of the NGT and Delphi technique, including the steps involved and the types of research questions best suited to each method, with examples from the pharmacy literature. Methodology The NGT entails face-to-face discussion in small groups, and provides a prompt result for researchers. The classic NGT involves four key stages: silent generation, round robin, clarification and voting (ranking). Variations have occurred in relation to generating ideas, and how ‘consensus’ is obtained from participants. The Delphi technique uses a multistage self-completed questionnaire with individual feedback, to determine consensus from a larger group of ‘experts.’ Questionnaires have been mailed, or more recently, e-mailed to participants. When to use The NGT has been used to explore consumer and stakeholder views, while the Delphi technique is commonly used to develop guidelines with health professionals. Method choice is influenced by various factors, including the research question, the perception of consensus required, and associated practicalities such as time and geography. Limitations The NGT requires participants to personally attend a meeting. This may prove difficult to organise and geography may limit attendance. The Delphi technique can take weeks or months to conclude, especially if multiple rounds are required, and may be complex for lay people to complete.
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            Adaptive Deep Brain Stimulation In Advanced Parkinson Disease

            Objective: Brain–computer interfaces (BCIs) could potentially be used to interact with pathological brain signals to intervene and ameliorate their effects in disease states. Here, we provide proof-of-principle of this approach by using a BCI to interpret pathological brain activity in patients with advanced Parkinson disease (PD) and to use this feedback to control when therapeutic deep brain stimulation (DBS) is delivered. Our goal was to demonstrate that by personalizing and optimizing stimulation in real time, we could improve on both the efficacy and efficiency of conventional continuous DBS. Methods: We tested BCI-controlled adaptive DBS (aDBS) of the subthalamic nucleus in 8 PD patients. Feedback was provided by processing of the local field potentials recorded directly from the stimulation electrodes. The results were compared to no stimulation, conventional continuous stimulation (cDBS), and random intermittent stimulation. Both unblinded and blinded clinical assessments of motor effect were performed using the Unified Parkinson's Disease Rating Scale. Results: Motor scores improved by 66% (unblinded) and 50% (blinded) during aDBS, which were 29% (p = 0.03) and 27% (p = 0.005) better than cDBS, respectively. These improvements were achieved with a 56% reduction in stimulation time compared to cDBS, and a corresponding reduction in energy requirements (p < 0.001). aDBS was also more effective than no stimulation and random intermittent stimulation. Interpretation BCI-controlled DBS is tractable and can be more efficient and efficacious than conventional continuous neuromodulation for PD. Ann Neurol 2013;74:449–457
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              Obsessive–compulsive disorder

              Obsessive–compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the ‘obsessive–compulsive and related disorders’, a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive–behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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                Author and article information

                Contributors
                Journal
                Front Neurol
                Front Neurol
                Front. Neurol.
                Frontiers in Neurology
                Frontiers Media S.A.
                1664-2295
                22 September 2021
                2021
                : 12
                : 722762
                Affiliations
                [1] 1Department of Neurosurgery, University Hospital Zurich , Zurich, Switzerland
                [2] 2Neurology Unit, Department of Internal Medicine, Hôpital Fribourgeois (HFR)–Cantonal Hospital Fribourg, University of Fribourg , Fribourg, Switzerland
                [3] 3Department of Neurology, Lausanne University Hospital and University of Lausanne , Lausanne, Switzerland
                [4] 4Department of Neurology, Geneva University Hospital and University of Geneva , Geneva, Switzerland
                [5] 5Department of Neurosurgery, Cantonal Hospital Aarau , Aarau, Switzerland
                [6] 6Department of Neurology, University Hospital Zurich , Zurich, Switzerland
                [7] 7Neurocenter, Lucerne Cantonal Hospital, University of Zurich , Zurich, Switzerland
                [8] 8Department of Neurology, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
                [9] 9Department of Neurology, Inselspital, University Bern , Bern, Switzerland
                [10] 10Department of Neurosurgery, Cantonal Hospital St. Gallen , St. Gallen, Switzerland
                [11] 11Parkinson Center, Center for Neurological Rehabilitation , Zihlschlacht, Switzerland
                [12] 12Department of Neurology, Center for Neurorehabilitation , Valens, Switzerland
                [13] 13Department of Neurology, Cantonal Hospital Aarau , Aarau, Switzerland
                [14] 14Center for Magnetic Resonance (MR) Research, University Children's Hospital Zurich , Zurich, Switzerland
                [15] 15Neurocenter of Southern Switzerland Ente Ospedaliero Cantonale (EOC), Regional Hospital Lugano , Lugano, Switzerland
                [16] 16Faculty of Biomedical Neurosciences, Università Della Svizzera Italiana , Lugano, Switzerland
                Author notes

                Edited by: Sanjay Pandey, University of Delhi, India

                Reviewed by: Aparna Wagle Shukla, University of Florida, United States; Raul Martinez Fernandez, Centro Integral en Neurociencias A.C. HM CINAC, Spain

                *Correspondence: Lennart H. Stieglitz Lennart.Stieglitz@ 123456usz.ch

                This article was submitted to Movement Disorders, a section of the journal Frontiers in Neurology

                Article
                10.3389/fneur.2021.722762
                8493868
                34630296
                cf89af89-ca98-44ae-8fa4-09917f676298
                Copyright © 2021 Stieglitz, Oertel, Accolla, Bally, Bauer, Baumann, Benninger, Bohlhalter, Büchele, Hägele-Link, Kägi, Krack, Krüger, Mahendran, Möller, Mylius, Piroth, Werner and Kaelin-Lang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 09 June 2021
                : 18 August 2021
                Page count
                Figures: 3, Tables: 1, Equations: 0, References: 43, Pages: 14, Words: 9331
                Categories
                Neurology
                Systematic Review

                Neurology
                focused ultrasound,hifus,mrghifus,consensus,movement disorders,parkinson,tremor
                Neurology
                focused ultrasound, hifus, mrghifus, consensus, movement disorders, parkinson, tremor

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