A-084 Magnetic Resonance-Guided Focused Ultrasound for Parkinson’s Disease: A Systematic and Qualitative Review of Nonmotor Cognitive Outcomes Since FDA Approval of ExAblate, 2016–2019

Abstract

Abstract Objective ExAblate received FDA approval for treatment of a range of movement disorders, including tremor-dominant Parkinson’s disease (TDPD), dyskinetic PD, and essential tremor. This incisionless device permits magnetic resonance-guided focused ultrasound (MRgFUS) for ablation of regions of interest. This systematic review sought to 1) determine the extent of literature on nonmotor cognitive outcomes of MRgFUS, 2) investigate differences in postoperative outcomes, 3) suggest future research directions. Data Selection PubMed, CINAHL, PsycINFO, Cochrane Library databases were searched January 2016 to January 2020. Guidelines for Preferred Reporting Items for Systematic Review and Meta-Analyses were used to review clinical trials comprehensively assessing pre- and postoperative neurocognitive functioning in PD patients undergoing MRgFUS. Due to limited literature, TDPD was expanded to dyskinetic PD. Data Synthesis Twenty-two abstracts were initially reviewed. After full-text review of eight articles, two studies included comprehensive neuropsychological evaluations of PD patients undergoing MRgFUS thalamotomy/pallidotomy—these occurred in different countries with different normative data, prohibiting quantitative comparison. Most excluded studies used only brief cognitive screeners with unsubstantiated cutoffs. Conclusions Few studies to-date have administered comprehensive neuropsychological batteries to ascertain MRgFUS risks to neurocognitive functioning in PD and how it compares to deep brain stimulation. Cognitive declines appear to be minimal following MRgFUS, with exceptions being verbal fluency and inhibition. These results are limited by sample size and sample diversity. Studies must extend beyond brief screeners when assessing PD populations vulnerable to decline. Further, consensus on a comprehensive battery would better serve replicability and the ability to engage in useful meta-analyses.