Objective: To report our clinical experience in the treatment of essential (ET) and Parkinson’s disease (PD) tremor with MRI guided High-Intensity Focused Ultrasound (MRgHIFU).

Background: Ablative neurosurgery for the treatment of movement disorders has been performed for decades. However, after the appearance of deep brain stimulation in the late 80’s, lesional strategies were practically relegated. Recent development of non-surgical low-invasive MRgHIFU has paved the way for the rebirth of ablative approaches.

Methods: Eight patients (7 ET, 1 PD) underwent unilateral thalamotomy with MRgHIFU.

Patient’s demography

P	Dx	Sex	Age	Disease duration (y)	Lesion side	Treatment-related adverse events
1	ET	F	74	15	L	Transitory gait and limb ataxia
2	ET	F	74	10	L	Transitory gait and limb ataxia
3	ET	M	64	11	L	Oral paresthesia
4	ET	M	87	25	L	Transitory subjective gait instability
5	ET	F	82	15	L	Fever secondary to microaspiration, mild gait ataxi
6	ET	F	66	34	L	Transitory gait and limb ataxia
7	ET	F	71	30	L	Transitory gait and limb ataxia, oral paresthesia
8	PD	F	77	12	R	Transitory gait ataxia

” In ET patients, tremor severity was assessed with the Clinical Rating Scale for Tremor (CRST) at baseline, 1 week and 1 month after treatment. Two patients were followed up to six months. A visual analogue scale (VAS) for the assessment of overall quality of life (ranging from 0 to 100% with higher scores indicating better perceived quality of life) was also given before treatment and 1 month after procedure. The single PD patient was evaluated through tremor subitems of the motor MDS-UPDRS. Treatment-related adverse events were also registered.

Results: At last follow-up mean CRST scores for tremor corresponding to the treated hemibody reduced from 9.1 to 1 (mean reduction of 90%). Total CRST score showed an improvement from 65.1 to 27.1 (60%). The part C of the CRST evaluating disability in activities of daily living improved from 20 to 2.5 (87.5%). In the PD patient tremor completely resolved. The VAS improved from 41% at baseline to 73% at 1-month follow-up. During the procedure, all patients complaint of nausea and/or headache with different degrees of severity. The most frequent postreatment adverse event was gait unstability and contralateral limb ataxia (five patients) which progressively improved in the follow-up. Two patients reported mild oral paresthesias. Further follow-up, size lesion and anatomo-clinical correlations will be presented.

Conclusions: The experience in our center (CINAC-HM Puerta del Sur) supports previous evidence showing that MRgHIFU is safe and effective for the treatment of ET and PD tremor, resulting in huge reduction of daily living disability. Larger, controlled and randomized trials are mandatory to confirm these findings.

« Back to 2016 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/mri-guided-high-intensity-focused-ultrasond-for-the-treatment-of-essential-tremor-and-parkinsons-disease-clinical-outcome-and-radiological-findings-of-unilateral-thalamotomy/