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. 2022;12(1):199-206.
doi: 10.3233/JPD-212810.

Focused Ultrasound Thalamotomy in Tremor Dominant Parkinson's Disease: Long-Term Results

Alon Sinai  1 , Maria Nassar  2 , Elliot Sprecher  2 , Marius Constantinescu  1 , Menashe Zaaroor  1 , Ilana Schlesinger  2   3
Affiliations

Focused Ultrasound Thalamotomy in Tremor Dominant Parkinson's Disease: Long-Term Results

Alon Sinai et al. J Parkinsons Dis. 2022.

Abstract

Background: MRI-guided focused ultrasound (FUS) has established short-term efficacy in tremor relief.

Objective: We report our long-term experience of treating tremor with unilateral FUS unilateral VIM-thalamotomy in tremor dominant Parkinson's disease (TDPD) patients.

Methods: We report outcome of FUS thalamotomy in TDPD patients with 1-5 years of follow-up.

Outcomes: tremor reduction assessed with Clinical Rating Scale for Tremor (CRST) and Unified Parkinson's Disease Rating Scale (UPDRS part III) overall and in the treated hemibody and safety.

Results: Twenty-six TDPD patients completed 1-5 years of follow-up (median follow-up 36 months, range 12-60 months). Median age was 60 years (range 46-79), with median disease duration of 6 years (range 2-16). Immediately, treatment resulted in 100%improvement in tremor in the treated arm in 23 patients and 90%improvement in 3 patients. In 15 patients with leg tremor, 2 patients with chin tremor and 1 patient with head tremor, tremor was significantly improved. Up to 5 years, median CRST score, median UPDRS score, overall and in treated hemibody, decreased significantly as compared with baseline (p < 0.0001). In 2 patients tremor returned completely and in 8 patients there was partial return of tremor. Adverse events were mild and resolved within 3 months. At baseline 4 patients were not receiving any medication vs. 3 at last follow-up and 15 were not taking levodopa vs.9 at last follow-up.

Conclusion: Unilateral FUS VIM-thalamotomy in TDPD patients was effective and safe and provided long-term tremor relief in most patients. FUS thalamotomy for tremor may delay initiation of levodopa treatment.

Keywords: Parkinson’s disease; surgery; treatment; tremor; ultrasound.

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Conflict of interest statement

Ilana Schlesinger was employed by the Rambam Healthcare Campus, received honoraria for a lecture sponsored by Insightec, and gave expert testimony as a consultant to the Disability Rehabilitation Division of the Israeli Ministry of Defense.

Menashe Zaaroor received honoraria for a lecture sponsored by Insightec and serves as a medical expert in the field of Neurosurgery on medical committees of the Disability Rehabilitation Division of the Israeli Ministry of Defense.

Alon Sinai received funding for travel to an Insightec investigator’s meeting.

Maria Nassar, Marius Constantinescu, and Elliot Sprecher have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Hemi-CRST score at baseline and at follow-up visits for all patients (thin lines) and median score (thick line).
Fig. 2
Fig. 2
Hemi-UPDRS score at baseline and at follow-up visits for all patients (thin lines) and median score (thick line).
See this image and copyright information in PMC

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