Objective: The study aims to show that unilateral MR-guided focused ultrasound (MRgFUS) treatment akinetic-rigid Parkinson’s disease (PD) can be safe and effective.

Background: Parkinson’s disease treatment consists of antiparkinson medication therapy and neurosurgical in case of levodopa-induced motor complications. Non-invasive destruction by MRgFUS has become a pleasant alternative for asymmetric and drug-resistant PD symptoms. This procedure was approved for use in the tremor-dominant form of PD [1] and in treating PD akinesia and dyskinesia [2, 3, 4].

Method: We performed MRgFUS treatment of six patients with non-tremor dominant PD, including 3 with levodopa-induced dyskinesia and fluctuations, 2 with motor fluctuations and without dyskinesia, and one without levodopa-induced motor complications. Their mean age was 54,67±3,30 years (range 40-64 years) with a mean disease duration of 9,67±1,82 years (range 6-18 years).

We selected the pallidothalamic tract (PTT) as a target for MRgFUS treatment due to its safety and efficacy in treating akinesia and dyskinesia in PD.

The primary outcome measures were the off-status score on the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale, part III (MDS-UPDRS III), and the score on the MDS-UPDRS, part IV (MDS-UPDRS IV) in the on-medication state. Secondary outcomes included changes from baseline to 1 month in the scores on III and IV parts of the MDS-UPDRS.

Results: The mean MDS-UPDRS-III scores decreased from 61,5 [50,25; 76,5] to 26,5 [23,5; 44,5] after treatment (p<0,05). The comparison to the baseline showed that MDS-UPDRS-IV significantly improved dyskinesia severity from 15 [5; 15] to 6 [5; 6] (p<0,05). Treatment reduced one patient’s painful off-period cervical dystonia, and he stopped taking levodopa.

Most adverse events were mild and transient. Adverse events during sonication included headache (n=2), short-lasting vertigo (n=3), nausea (n=1), and arterial hypertension (n=1). Adverse events that lasted after the procedure included gait ataxia (n=5), instability (n=3), and hand ataxia (n=2). No adverse event lasted beyond three months.

Conclusion: Our experience shows that MRgFUS pallidothalamic tractotomy can be a safe and effective treatment for akinesia, rigidity, and dyskinesia in akinetic-rigid PD patients. We need to conduct long-term observations.

References: 1. Bond AE, Shah BB, Huss DS, Dallapiazza RF et al. Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson’s disease: a randomized clinical trial. JAMA Neurol. 2017 Dec 1;74(12):1412-1418.
2. Eisenberg HM, Krishna V, Elias WJ, Cosgrove GR et al. MR-guided focused ultrasound pallidotomy for Parkinson’s disease: safety and feasibility. J Neurosurg. 2020 Nov 27:1-7.
3. Gallay MN, Moser D, Rossi F, Magara AE et al. MRgFUS Pallidothalamic tractotomy for chronic therapy-resistant Parkinson’s disease in 51 consecutive patients: single center experience. Front Surg. 2020 Jan 14;6:76
4. Horisawa S, Fukui A, Yamahata H, Tanaka Y et al. Unilateral pallidothalamic tractotomy for akinetic-rigid Parkinson’s disease: a prospective open-label study. J Neurosurg. 2021 Jan 15:1-7.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mr-guided-focused-ultrasound-pallidothalamic-tractotomy-in-non-tremor-dominant-akinetic-rigid-parkinsons-disease-treatment/