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Focused ultrasound subthalamotomy in patients with Parkinson disease

Magnetic resonance imaging (MRI)-guided focused ultrasound (FUS) subthalamotomy is under investigation in patients with Parkinson disease (PD) but does not yet have regulatory approval. In a sham-controlled trial of unilateral FUS subthalamotomy in 40 patients with markedly asymmetric PD and prominent tremor, motor scores improved by approximately 50 percent over baseline at four months, compared with 10 percent in the sham group [1]. Transient dysarthria, gait disturbance, and dyskinesia were common after the procedure, and a small number of patients had persistent deficits at one year. Deep brain stimulation (DBS) remains our preferred surgical approach to treating disabling motor complications and tremor in PD, but if further study confirms these findings and provides evidence for long-term benefit, FUS subthalamotomy may become an alternative for selected patients who are not eligible for DBS.

See 'Device-assisted and lesioning procedures for Parkinson disease', section on 'MRI-guided focused ultrasound'.

1. Martínez-Fernández R, Máñez-Miró JU, Rodríguez-Rojas R, et al. Randomized Trial of Focused Ultrasound Subthalamotomy for Parkinson's Disease. N Engl J Med 2020; 383:2501.



Effectiveness of strength training in older adults

Strength training is an important health intervention that can help to prevent skeletal muscle atrophy, loss of strength, osteopenia, frailty, and insulin resistance in older adults, but the effectiveness of such training has been questioned in the very old. In a systematic review and meta-analysis of 22 randomized trials involving more than 800 adults over 75 years of age, strength training produced statistically significant and clinically meaningful increases in strength and muscle size [1]. These results held true even for the individuals 80 years or older. No major adverse effects were reported. Older individuals represent a far more heterogenous training population than younger adults and require a high degree of individualization when selecting exercises and designing a strength program. Nevertheless, the same general principles of strength training apply across all age groups.

See 'Practical guidelines for implementing a strength training program for adults', section on 'Important considerations for strength training in older adult patients'.

2. Grgic J, Garofolini A, Orazem J, et al. Effects of Resistance Training on Muscle Size and Strength in Very Elderly Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Sports Med 2020; 50:1983.



Refeeding inpatients with anorexia nervosa

Nutritional rehabilitation for anorexia nervosa often begins with lower-calorie diets to mitigate the risk of the refeeding syndrome, but these diets may lead to poorer outcomes. A randomized trial that compared higher-calorie with lower-calorie refeeding in 111 malnourished, medically unstable inpatients with anorexia nervosa (mean age 16 years) found greater benefits with the higher calorie diet [1]. The higher-calorie group began at 2000 kcal/day and increased by 200 kcal/day, whereas the lower-calorie group began at 1400 kcal/day and increased by 200 kcal every two days. Higher-calorie refeeding reduced the mean time to medical stability (7 versus 10 days) and increased weight gain; the incidence of electrolyte abnormalities was similar for both groups. We typically begin inpatient nutritional rehabilitation with approximately 1500 to 2000 kcal/day.

See 'Anorexia nervosa in adults and adolescents: Nutritional rehabilitation (nutritional support)', section on 'Number of calories'.

3. Garber AK, Cheng J, Accurso EC, et al. Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa: A Multicenter Randomized Clinical Trial. JAMA Pediatr 2021; 175:19.

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