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The role of high-intensity focused ultrasound as a symptomatic treatment for Parkinson's disease.
Mov Disord 2019MD

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.

Authors+Show Affiliations

Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain.Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.CINAC (Centro Integral de Neurociencias), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid, Spain.University of Maryland School of Medicine, Baltimore, Maryland, USA.University of Maryland School of Medicine, Baltimore, Maryland, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31291491

Citation

Moosa, Shayan, et al. "The Role of High-intensity Focused Ultrasound as a Symptomatic Treatment for Parkinson's Disease." Movement Disorders : Official Journal of the Movement Disorder Society, 2019.
Moosa S, Martínez-Fernández R, Elias WJ, et al. The role of high-intensity focused ultrasound as a symptomatic treatment for Parkinson's disease. Mov Disord. 2019.
Moosa, S., Martínez-Fernández, R., Elias, W. J., Del Alamo, M., Eisenberg, H. M., & Fishman, P. S. (2019). The role of high-intensity focused ultrasound as a symptomatic treatment for Parkinson's disease. Movement Disorders : Official Journal of the Movement Disorder Society, doi:10.1002/mds.27779.
Moosa S, et al. The Role of High-intensity Focused Ultrasound as a Symptomatic Treatment for Parkinson's Disease. Mov Disord. 2019 Jul 10; PubMed PMID: 31291491.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of high-intensity focused ultrasound as a symptomatic treatment for Parkinson's disease. AU - Moosa,Shayan, AU - Martínez-Fernández,Raul, AU - Elias,W Jeffrey, AU - Del Alamo,Marta, AU - Eisenberg,Howard M, AU - Fishman,Paul S, Y1 - 2019/07/10/ PY - 2019/04/09/received PY - 2019/04/30/revised PY - 2019/05/02/accepted PY - 2019/7/11/entrez KW - Parkinson's disease KW - focused ultrasound KW - movement disorders KW - pallidotomy KW - stereotactic surgery KW - subthalamotomy KW - thalamotomy JF - Movement disorders : official journal of the Movement Disorder Society JO - Mov. Disord. N2 - 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. SN - 1531-8257 UR - https://www.unboundmedicine.com/medline/citation/31291491/The_role_of_high-intensity_focused_ultrasound_as_a_symptomatic_treatment_for_Parkinson's_disease L2 - https://doi.org/10.1002/mds.27779 DB - PRIME DP - Unbound Medicine ER -