Objective: To report a case of a 44 years old male patient suffering from Parkinson’s disease for several years. DAT Scan SPECT confirmed the presynaptic dopaminergic deficit. The patient presented a tremor dominant syndrome resistant to sufficient medical treatment. Deep brain stimulation was no therapeutic option due to comorbidity with former drug abuse. That is why we offered the patient unilateral MR-guided high intensity focused ultrasound (MRgFUS) ablation of the pallido-thalamic-tract (PTT, fasciculus thalamicus) as another therapeutic option.

Background: MR-guided focused ultrasound (MRgFUS) is a novel technique which allows ablation of deep brain structures under direct MR guidance without affecting surrounding tissue. Lesions and mainly stimulation within the pallido-thalomo-cortical network (STN, GPi and Vim) are established stereotactic targets to treat parkinsonism. Lesional studies have shown that ablation (radiofrequency, MRgFUS) of the PTT within the subthalamic area is an effective approach to treat parkinsonian symptoms like bradykinesia, tremor and rigidity.

Method: Retrospective case report out of an ongoing trial. The PD patient fulfilled current criteria for DBS therapy and received unilateral (left) ablation of the PTT using the ExAblate Neuro MRgFUS system. Reason against DBS was malcompliance due to polytoxicomania. The observation period was 5 years. The UPDRS III Score was recorded prior to and 6 months after the intervention. Pre and 6 month post intervention neuropsychological assessments are available.

Results: The UPDRS III score improved from 23.0 in the best on status prior to the intervention to 15.0 in the best on status 6 months after the intervention lasting up to 5 year follow up. UPDRS III was performed every 6 months. The improvement in UPDRS III is due to complete recovery of contralateral tremor. The Hoehn and Yahr scale did not change after the intervention. No other adverse events were observed.

Conclusion: This case shows that unilateral MRgFUS of the pallido-thalamic tract (PTT) seems to be a safe and effective treatment alternative to DBS for patients with PD especially in tremordominant syndromes. Our patient showed long-term benefit over a 5 year period.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mr-guided-high-intensity-focused-ultrasound-in-parkinsons-disease-a-case-report-with-a-5-year-follow-up/