Abstract
Background. Thalamotomy is effective in alleviating tremor in Parkinson's disease (PD). Methods. Seven PD patients, mean age 59.4 ± 9.8 years (range, 46–74) with a mean disease duration of 5.4 ± 2.8 years (range, 2–10) suffering from severe refractory tremor, underwent ventral intermediate nucleus thalamotomy using MRI guided focused ultrasound (MRgFUS), an innovative technology that enables noninvasive surgery. Results. Tremor stopped in the contralateral upper extremity in all patients immediately following treatment. Total UPDRS decreased from 37.4 ± 12.2 to 18.8 ± 11.1 (p = 0.007) and PDQ-39 decreased from 42.3 ± 16.4 to 21.6 ± 10.8 (p = 0.008) following MRgFUS. These effects were sustained (mean follow-up 7.3 months). Adverse events during MRgFUS included headache (n = 3), dizziness (n = 2), vertigo (n = 4), and lip paresthesia (n = 1) and following MRgFUS were hypogeusia (n = 1), unsteady feeling when walking (n = 1, resolved), and disturbance when walking tandem (n = 1, resolved). Conclusions. Thalamotomy using MRgFUS is safe and effective in PD patients. Large randomized studies are needed to assess prolonged efficacy and safety.
Highlights
Thalamotomy is effective in alleviating tremor in Parkinson’s disease (PD)
Deep brain stimulation (DBS) to the ventral intermediate thalamic nucleus (VIM), globus pallidus internus, and subthalamic nucleus are beneficial in improving PD tremors [3] but their drawbacks are high costs and high complication rates [4]
We report our experience with thalamotomy using MRI guided focused ultrasound (MRgFUS) in PD patients with medication resistant tremor
Summary
Tremor is the most common symptom of Parkinson’s disease (PD), observed in about 50% of patients at the time of diagnosis. Current medications primarily target bradykinesia and rigidity with unpredictable responsiveness of tremor [2]. Surgical treatment options are available for patients with debilitating tremors. Lesions are generated by gradual focal heating with the lesion’s location and temperature controlled and monitored by MRI. During the initial reversible low temperature focal heating, patients are observed for transient positive and adverse clinical effects prior to irreversible high temperature ablation. The treatment’s impact on the tremor is monitored clinically during the procedure. We report our experience with thalamotomy using MRgFUS in PD patients with medication resistant tremor
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