MRI-Guided Focused Ultrasound in Parkinson's Disease and Essential Tremor: Incisionless but Invasive. A Narrative Review.
Authors: Metta V, Benamer HTS, Kapsas G, Mridula R, Alugolu R, Hussain H, Nalarakettil A, Sai SKN, Elmahdy M, Borgohain R, Chaudhuri KR
Magnetic resonance-guided focused ultrasound (MRgFUS) is an emerging and promising technology for treating movement disorders, such as essential tremors and tremor-dominant Parkinson's disease. MRgFUS utilizes advanced ultrasound transducer emitters to condense sound waves at a precisely defined point. This technology can target various brain areas, such as the pallidothalamic tract, thalamus, and pallidum, to ameliorate some of the symptoms of Parkinson's disease and other movement disorders, such as dystonic and action-induced tremors. We review the current status of preclinical and clinical trials on the clinical use, treatment outcomes, and indications of MRgFUS.
Introduction
Purpose
Thermal ablation
Study Objective
To review the current preclinical and clinical trial evidence on the clinical use, treatment outcomes, and indications of MR-guided focused ultrasound for movement disorders.
Disease model
Movement disorders (essential tremor, tremor-dominant Parkinson's disease, dystonia)
MRI or image guidance method
Magnetic resonance-guided (MRgFUS)
Targeted brain region(s)
Pallidum
Outcomes and Safety
Summary of Outcomes
MRgFUS produces significant short‑term reduction of medication‑resistant tremor in essential tremor and Parkinson’s disease with generally transient, mostly reversible side effects (ataxia, balance problems, numbness) and no reported bleeding or infections, though long‑term durability and symptom recurrence remain concerns. Successful MRgFUS targets reported include VIM thalamotomy, pallidothalamic tract (PTT), pallidotomy, and subthalamotomy/STN‑FUS (GPi‑FUS results less convincing), and staged bilateral MRgFUS (>1 year interval) has been effective for bilateral ET.
Duration of biological effect
Up to 5 years
Safety-related matter
Adverse events were reported more frequently with MRgFUS than with DBS but were generally less severe and mostly reversible; common complications included ataxia, balance/gait disturbances and persistent numbness, while no bleeding or infections have been reported and no evidence of long-term cognitive/emotional deterioration has emerged so far. Overall patients experienced significant benefit with few transient side effects, though long-term data are limited and symptom recurrence has been noted.
Brain Region
Ultrasound Parameters
Focal Characteristics
focal depth: None; focal length: None; aperture size: None
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