Objective: To study the efficacy and safety of this treatment in a similar cohort of patients and to characterize the lesions.

Background: Unilateral subthalamic nucleus (STN) ablation by magnetic resonance-guided focused ultrasound (MRgFUS) seems safe and effective for asymmetric Parkinson’s disease (PD).

Method: Prospective, single-center open-label study in asymmetric PD patients evaluated at 6 (n=20) and 12 months (n=12) after MRgFUS-subthalamotomy (Table 1). The primary outcome was the change in the MDS-UPDRS-III in off-medication in the treated side and the adverse events (AEs) at 6-month follow-up. We also evaluated cognitive–neuropsychological changes, self-assessment of clinical improvement, and the correlation of the lesion volume and coordinates with the motor outcomes.

Results: The MDS-UPDRS III score and all subscores on the treated side were improved (P< 0.001) throughout the follow-up compared to baseline (reductions at 6 months: rigidity 83.5%, bradykinesia 69.4%, tremor 91.5%) (Table 2). One patient had severe weakness in the treated hemibody, one moderate dyskinesia on the treated leg, and one moderate confusional state that became mild or had disappeared at 6 months follow-up. The rest of AEs were mild and mostly transient (Table 3). We observed no clinically relevant changes in cognitive-neuropsychological tests. The percentage of ablation of the motor region of the STN correlated with the improvement in the contralateral MDS-UPDRS III, tremor, and bradykinesia scores (P<0.05) (Figure 1). All but two patients self-rated as “much improved” or “very much improved” (Figure 2).

Conclusion: Unilateral MRgFUS-subthalamotomy targeting the motor-STN resulted in a significant motor improvement. We observed no persistent severe AEs, although mild, mostly transient AEs were frequent.

Table 1

Table 2

Table 3

Figure 1

Figure 2

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MDS Abstracts - https://www.mdsabstracts.org/abstract/unilateral-mrgfus-subthalamotomy-in-parkinsons-disease-a-prospective-clinical-study/