Delaram Safarpour

BACKGROUND AND OBJECTIVES: Staged bilateral magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is increasingly performed for medication-refractory essential tremor, yet the relationship between lesion characteristics and profiles of adverse events (AE) across sessions remains poorly characterized. We sought to examine how lesion volume, stereotactic coordinates, and session order relate to AE profiles in staged bilateral MRgFUS thalamotomy. METHODS: Retrospective analysis of 50 patients who underwent staged bilateral MRgFUS thalamotomy at a single center. AE were assessed at postoperative day 1 and 3-month follow-up. Lesion volumes were categorized into tertiles from the pooled distribution. Stereotactic coordinates were normalized to anterior commissure-posterior commissure distance. Linear regression assessed associations between coordinates and AE. RESULTS: The second session was characterized by fewer sonications (6.0 ± 1.9 vs 6.5 ± 1.4, P = .013), lower peak temperatures (56.4 ± 2.9°C vs 57.3 ± 2.3°C, P = .044), and smaller lesion volumes (168.5 ± 107.7 mm ³ vs 198.7 ± 85.1 mm ³ , P = .007), consistent with a conservative approach that maintained comparable tremor outcomes. At 3 months, AE rates were higher after the second session for gait/balance disturbance (44.0% vs 18.0%, P = .016) and sensory abnormalities (24.0% vs 8.0%, P = .033), despite similar immediate postoperative profiles. This divergence was volume-dependent, small lesions (126.8 mm ³ or less) showed comparable rates between sessions, whereas medium and large lesions demonstrated substantially higher second-session rates. More posterior positioning was independently associated with speech deficits ( P = .001) and mouth numbness ( P = .014). CONCLUSION: AE persistence after the second session was volume-dependent, with rates comparable to the first session at smaller lesion volumes but elevated at larger volumes. Posterior lesion positioning was independently associated with mouth numbness and speech deficits, supporting anterior targeting adjustments for contralateral procedures. These findings suggest that lesion volume constraint combined with anterior positioning may optimize the safety profile of staged bilateral MRgFUS thalamotomy, although prospective validation is needed to establish definitive volume thresholds.

Dysphagia is a common and often underrecognized symptom in patients with Parkinson's disease (PD) that is frequently overlooked during hospitalization. Dysphagia may be present without overt clinical signs, complicating timely identification and intervention. The absence of clear guidelines for managing dysphagia in hospitalized patients with PD often results in delays in medication administration, with subsequent deterioration in both motor and non-motor symptoms. This consensus paper, developed through collaboration among experts in otolaryngology, gastroenterology, neurology, hospital medicine, nursing, social work, speech-language pathology, pharmacy, and nutrition, presents comprehensive recommendations for the evaluation and management of dysphagia in hospitalized patients with PD. These guidelines emphasize the importance of early screening, appropriate diagnostic evaluation, and multidisciplinary involvement to support timely and safe oral intake and sustained medication schedules. Special consideration is given to the role of alternative medication formulations and compensatory strategies when swallowing impairments are identified. Recognizing the variability in access to specialty care, especially in rural and community hospital settings, these recommendations also provide practical tools for providers. They outline when to initiate swallowing evaluations, criteria for specialist referral, use of telemedicine for consultations with specialists, and strategies to bridge care from the inpatient to outpatient setting. By implementing these consensus guidelines, healthcare teams can improve the safety, outcomes, and hospital experience of patients with PD, while reducing complications and length of stay associated with dysphagia-related issues. Plain language title: Consensus expert recommendations for management of swallowing difficulties in patients with Parkinson's disease during hospitalization

Deep brain Stimulation (DBS) surgery effectively alleviates troublesome motor symptoms of Parkinson’s disease (PD) such as tremor, rigidity, bradykinesia, motor fluctuations and dyskinesia. It also improves some non-motor symptoms and quality of life. DBS should thus be considered when these symptoms interfere with quality of life despite optimal medical treatment. While DBS benefits are clear, access by eligible patients remains low. Patients and their caregivers should be educated regarding DBS surgery and referrals for surgical evaluation should occur alongside ongoing medication adjustments—particularly when those changes fail to adequately control motor symptoms—regardless of the stage of disease progression. This international panel of DBS experts developed consensus recommendations with the goals of promoting timely referrals and approvals, while reducing misconceptions and stigma associated with brain surgery. These recommendations provide a framework for referring providers, ensuring that appropriate candidates receive timely access to this beneficial treatment.

Background: Gait and mobility impairments are early markers of disease‐related decline in individuals with Friedreich's ataxia (FRDA). Objectives: This study aimed to identify the digital gait measures most discriminative of individuals with FRDA from healthy controls (HC) during an instrumented walking assessment. We also investigated if top discriminative gait measures correlated with disease severity. Methods: We recruited 24 participants with FRDA and 24 HCs to complete a 2‐min walk at a natural pace while wearing six wearable sensors on the hands, feet, sternum, and lower lumbar area. AUCs between FRDA and HC compared 51 gait measures, including standard deviations as estimates of variability, to discriminate between ataxic and normal gait. Spearman's correlation coefficients assessed the relationships between the most discriminative measures and ataxia severity from clinical outcome measures. Results: We identified 10 measures with strong discriminative ability for gait characteristics of FRDA. The most discriminative measure was double‐support time SD (AUC = 0.98, ICC = 0.95); a measure of variability. Eight out of the 10 most discriminate measures involved excessive gait variability in the FRDA group. The top five discriminative gait measures significantly correlated with the mFARS USS ( r = 0.45–0.63) and two discriminative gait measures significantly correlated with the FARS ADL ( r = 0.62 and 0.5). Test–retest reliability of the top measures were high (ICC = 0.85–0.98). Conclusions: Digital gait measures from wearable sensors were discriminative, reliable, and showed concurrent validity for evaluating ataxia severity during an instrumented walk test. These results suggest promising utility of digital gait outcomes for use in FRDA clinical trials.

Thermoregulatory dysfunction—temperature intolerance and/or inappropriate compensation—is an underrecognized feature of Parkinson’s disease (PD) and is linked to poor quality of life. Multiple mechanisms may underlie this dysfunction, including α-synuclein deposition in relevant structures, altered functional connectivity in thermoregulatory networks, and disrupted neurotransmitter modulation, on top of the deleterious consequences of aging. Although multiple advanced tests can confirm this dysfunction, diagnosis is largely based on a detailed history. Once this critical symptom is identified, management focuses on crisis prevention and safety, as PD-specific clinical trials are often lacking. This narrative review of the literature addresses mechanisms, clinical expression, diagnostic evaluation, and management of thermoregulatory dysfunction in PD to help guide care for this underappreciated, yet potentially debilitating, non-motor symptom of PD. Future PD-specific trials are needed to further clarify underlying mechanisms and improve treatment options.