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. 2024 Jul;271(7):3731-3742.
doi: 10.1007/s00415-024-12469-z. Epub 2024 May 31.

Motor and non-motor outcome in tremor dominant Parkinson's disease after MR-guided focused ultrasound thalamotomy

Veronika Purrer  1   2 , Emily Pohl  3 , Valeri Borger  4 , Hannah Weiland  5 , Henning Boecker  6   5 , Frederic Carsten Schmeel  6   7 , Ullrich Wüllner  3   6
Affiliations

Motor and non-motor outcome in tremor dominant Parkinson's disease after MR-guided focused ultrasound thalamotomy

Veronika Purrer et al. J Neurol. 2024 Jul.

Abstract

Background and objectives: Magnetic Resonance-guided Focused Ultrasound (MRgFUS) is an emerging technique for the treatment of severe, medication-refractory tremor syndromes. We here report motor and non-motor outcomes 6 and 12 months after unilateral MRgFUS thalamotomy in tremor-dominant Parkinson's disease (tdPD).

Methods: 25 patients with tdPD underwent neuropsychological evaluation including standardized questionnaires of disability, quality of life (QoL), mood, anxiety, apathy, sleep disturbances, and cognition at baseline, 6 and 12 months after MRgFUS. Motor outcome was evaluated using the Clinical Rating Scale for Tremor (CRST) and Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). In addition, side effects and QoL of family caregivers were assessed.

Results: 12 months after MRgFUS significant improvements were evident in the tremor subscores. Patients with concomitant rest and postural tremor showed better tremor outcomes compared to patients with predominant rest tremor. There were no differences in the non-motor assessments. No cognitive decline was observed. Side effects were mostly transient (54%) and classified as mild (62%). No changes in the caregivers' QoL could be observed.

Conclusion: We found no changes in mood, anxiety, apathy, sleep, cognition or persistent worsening of gait disturbances after unilateral MRgFUS thalamotomy in tdPD. Concomitant postural tremors responded better to treatment than predominant rest tremors.

Keywords: Focused ultrasound; Non-motor symptoms; Parkinson’s disease; Thalamotomy; Tremor.

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Conflict of interest statement

Ullrich Wüllner served as consultant and lecturer and on advisory boards for Bayer AG, STADA Pharm and Zambon; he received grants from the Federal Ministry of Education and Research (BMBF), the German Research Foundation (DFG) and the Deutsche Parkinson Vereinigung e.V. Henning Boecker received grants from the German Research Foundation (DFG) and BONFOR Forschungsförderprogramm of the Faculty of Medicine, University Bonn.

Figures

Fig. 1
Fig. 1
Tremor improvement after MRI-guided focused ultrasound (MRgFUS) thalamotomy in patients with concomitant rest and postural and predominant rest tremor subtype. 12 months post-MRgFUS, significant tremor improvement was observed in the treated extremity—as shown by modified, hand-specific subscores of the Clinical Rating Scale of Tremor (CRST)—in patients with concomitant rest and postural tremor only
See this image and copyright information in PMC

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