Objective: To assess the safety and efficacy of focused ultrasound subthalamotomy (FUS-STN) for Parkinson´s disease (PD) in patients who received the procedure within the first 5 years since diagnosis (early PD).

Background: FUS-STN improves cardinal motor signs in early PD patients up to one year after the procedure. Whether this benefit persists beyond this timeframe impacting disease progression is unexplored.

Method: Prospective open-label study including asymmetrical PD patients, who underwent unilateral FUS-STN within the first 5 years from diagnosis. Patients were followed up for 3 years after the procedure. The primary outcome was the difference from baseline to 36 months after FUS-STN in the MDS-UPDRS III (off-med) for the treated side. Secondary outcomes were the change in the MDS-UPDRS III (on-med); subscores of rigidity, bradykinesia, tremor; total MDS-UPDRS III; MDS-UPDRS part IV; functional disability (MDS-UPDRS II); quality of life (PDQ39); levodopa equivalent daily dose (LEDD). Adverse events were collected. Non-parametric repeated measures ANOVA was applied for analysis.

Results: Twelve patients were included and all of them were available for the 36-month visit. The mean(±SD) age at baseline was 52.9±7.1 years, with a mean disease duration of 3.1±1.2 years. The MDS-UPDRS III score for the treated side off-med was improved by 66.7% from baseline (from 14.8±2.9 to 5.1±2.7, p<0.001). All motor features were improved. No disabling or new adverse events were reported. The total MDS-UPDRS III off-med score was 48.6% lower at 3 years than before FUS-STN (from 27.4±5.5 to 14.8±8.2, p<0.001). LEDD remained stable 3 years after the procedure (from 643.2±275.2 to 643.4±337.2 mg, n.s.). The MDS-UPDRS IV, II, and PDQ39 scores were equivalent to those at baseline.

Conclusion: FUS-STN provides a sustained motor benefit in early PD patients without safety concerns or management complications. Whether the early treatment improves disease evolution requires a properly designed trial.

References: Martínez Fernández, Raúl et al. “Unilateral focused ultrasound subthalamotomy in early Parkinson’s disease: a pilot study.” Journal of neurology, neurosurgery, and psychiatry vol. 95,3 206-213. 14 Feb. 2024, doi:10.1136/jnnp-2023-331211

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MDS Abstracts - https://www.mdsabstracts.org/abstract/focused-ultrasound-subthalamotomy-in-early-parkinsons-disease-three-year-prospective-follow-up/