Magnetic Resonance-Guided Focused Ultrasound Thalamotomy May Spare Dopaminergic Therapy in Early-Stage Tremor-Dominant Parkinson's Disease: A Pilot Study

Mov Disord. 2022 Nov;37(11):2289-2295. doi: 10.1002/mds.29200. Epub 2022 Aug 29.

Abstract

Background: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is a safe and effective procedure for drug-resistant tremor in Parkinson's disease (PD).

Objective: The aim of this study was to demonstrate that MRgFUS ventralis intermedius thalamotomy in early-stage tremor-dominant PD may prevent an increase in dopaminergic medication 6 months after treatment compared with matched PD control subjects on standard medical therapy.

Methods: We prospectively enrolled patients with early-stage PD who underwent MRgFUS ventralis intermedius thalamotomy (PD-FUS) and patients treated with oral dopaminergic therapy (PD-ODT) with a 1:2 ratio. We collected demographic and clinical data at baseline and 6 and 12 months after thalamotomy.

Results: We included 10 patients in the PD-FUS group and 20 patients in the PD-ODT group. We found a significant increase in total levodopa equivalent daily dose and levodopa plus monoamine oxidase B inhibitors dose in the PD-ODT group 6 months after thalamotomy.

Conclusions: In early-stage tremor-dominant PD, MRgFUS thalamotomy may be useful to reduce tremor and avoid the need to increase dopaminergic medications. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: MRgFUS; Parkinson's disease; VIM; thalamotomy; tremor.

MeSH terms

  • Essential Tremor* / drug therapy
  • Essential Tremor* / surgery
  • Humans
  • Levodopa / therapeutic use
  • Magnetic Resonance Imaging / methods
  • Magnetic Resonance Spectroscopy
  • Parkinson Disease* / drug therapy
  • Parkinson Disease* / surgery
  • Pilot Projects
  • Thalamus / diagnostic imaging
  • Thalamus / surgery
  • Treatment Outcome
  • Tremor / drug therapy
  • Tremor / etiology
  • Tremor / surgery

Substances

  • Levodopa