The role of high‐intensity focused ultrasound as a symptomatic treatment for Parkinson's disease

Abstract

MR‐guided focused ultrasound is a novel, minimally invasive surgical procedure for symptomatic treatment of PD. With this technology, the ventral intermediate nucleus, STN, and internal globus pallidus have been targeted for therapeutic cerebral ablation, while also minimizing the risk of hemorrhage and infection from more invasive neurosurgical procedures. In a double‐blinded, prospective, sham‐controlled randomized controlled trial of MR‐guided focused ultrasound thalamotomy for treatment of tremor‐dominant PD, 62% of treated patients demonstrated improvement in tremor scores from baseline to 3 months postoperatively, as compared to 22% in the sham group. There has been only one open‐label trial of MR‐guided focused ultrasound subthalamotomy for patients with PD, demonstrating improvements of 71% for rigidity, 36% for akinesia, and 77% for tremor 6 months after treatment. Among the two open‐label trials of MR‐guided focused ultrasound pallidotomy for patients with PD, dyskinesia and overall motor scores improved up to 52% and 45% at 6 months postoperatively. Although MR‐guided focused ultrasound thalamotomy is now approved by the U.S. Food and Drug Administration for treatment of parkinsonian tremor, additional high‐quality randomized controlled trials are warranted and are underway to determine the safety and efficacy of MR‐guided focused ultrasound subthalamotomy and pallidotomy for treatment of the cardinal features of PD. These studies will be paramount to aid clinicians to determine the ideal ablative target for individual patients. Additional work will be required to assess the durability of MR‐guided focused ultrasound lesions, ideal timing of MR‐guided focused ultrasound ablation in the course of PD, and the safety of performing bilateral lesions. © 2019 International Parkinson and Movement Disorder Society

Blood–brain barrier opening with focused ultrasound in experimental models of Parkinson's disease

“…This includes targeting either the ventral intermediate thalamus, the subthalamic nucleus, or the internal pallidum. [80][81][82][83] Phase I trials exploring both of these indications are currently underway (NCT03608553). However, the use of FUS to disrupt the BBB in a focal and temporary way and facilitate the entry of different compounds such as GDNF, antiinflammatory drugs, or antibodies seems to be an extremely promising therapeutic option for the treatment of PD not only as a symptomatic treatment but also to impact the mechanisms underlying neurodegeneration.…”

Globus Pallidus Internus (GPi) Deep Brain Stimulation for Parkinson’s Disease: Expert Review and Commentary

“…These complications significantly impair quality of life and can transform into one of the major sources of disability in PD patients [ 4 ]. Invasive approaches, such as ablative procedures [ 5 , 6 ], carbidopa/levodopa intestinal gel [ 7 ], subcutaneous apomorphine infusions and deep brain stimulation (DBS) [ 8 ], have been utilized over the past 3 decades to address these PD-related symptoms. Evolving from lesional therapies, DBS is a modality that can be applied to various brain regions, with the globus pallidus interna (GPi) and subthalamic nucleus (STN) being the most common targets of DBS for the management of PD.…”

Comment on “The Role of High‐Intensity Focused Ultrasound as a Symptomatic Treatment for Parkinson's Disease”

“…We thank Dr. Xu and colleagues for their careful review of our article. 1 In response, while Magara and colleagues did publish the first case series describing the use of MR-guided focused ultrasound (MRgFUS) for the treatment of Parkinson's disease (PD), not all patients in this study had a primary complaint of tremor. 2 The study by Schlesinger and colleagues only included patients with tremor-dominant PD, and we therefore characterized this study as the first published case series describing the use of MRgFUS for the symptomatic treatment of tremor-dominant PD.…”

“…MR‐guided focused ultrasound (MRgFUS) neurosurgery is a new option for treatment of Parkinson's disease (PD). In a recent issue of Movement Disorders , Moosa and colleagues published an attractive and informative review article about the treatment of PD with MRgFUS . However, the review seems inaccurate in some places.…”

“…In a recent issue of Movement Disorders, Moosa and colleagues published an attractive and informative review article about the treatment of PD with MRgFUS. 1 However, the review seems inaccurate in some places. First, it was stated in the review that Schlesinger and colleagues published the first case series describing the use of MRgFUS for treatment of tremor-dominant PD.…”