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Meta-Analysis
. 2024 Sep 27;47(1):701.
doi: 10.1007/s10143-024-02948-2.

Magnetic resonance-guided focused ultrasound ventral intermediate thalamotomy for Tremor-Dominant Parkinson's disease: a systematic review and meta-analysis

Júlia Dos Santos Monteiro  1 , Beatriz Borba E Silva  2 , Rafael Reis de Oliveira  3 , Pedro G L B Borges  4 , Maria Antônia Oliveira Machado Pereira  5 , Kallyto Amorim Costa  6 , André Luis Silva Nunes  6 , João Paulo Mota Telles  7 , Marcelo Moraes Valença  8
Affiliations
Meta-Analysis

Magnetic resonance-guided focused ultrasound ventral intermediate thalamotomy for Tremor-Dominant Parkinson's disease: a systematic review and meta-analysis

Júlia Dos Santos Monteiro et al. Neurosurg Rev. .

Abstract

Introduction: Tremor-dominant Parkinson's Disease (TDPD) has a slower neurological decline compared to other phenotypes of the disease, but significantly impacts daily activities and is often less responsive to standard medications. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) lesioning of the Ventral Intermediate (VIM) nucleus of the thalamus may alleviate symptoms for these patients.

Methods: A systematic review and meta-analysis of English-language studies from PubMed, Cochrane, and Embase were conducted, assessing the efficacy and safety of MRgFUS VIM thalamotomy in TDPD patients. Tremor scores were evaluated using the Clinical Scale Rating for Tremor and the Movement Disorders Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRSIII). Neuropsychological outcomes were measured using the Parkinson Disease Questionnaire (PDQ) and the Montreal Cognitive Assessment. This analysis adhered to Cochrane and PRISMA guidelines.

Results: Thirteen studies with 211 patients were included. MDS-UPDRSIII scores showed significant improvement at 1, 6, and 12 months post-MRgFUS, respectively: (MD -8.92 points, 95% CI: -15.44 to -2.40, p < 0.01; MD -7.39 points, 95% CI: -11.47 to -3.30, p < 0.01; MD -10.66 points, 95% CI: -16.89 to -4.43, p < 0.01). PDQ scores at baseline compared to 6 months post-treatment also indicated a significant improvement (SMD - 0.86, 95% CI: -1.21 to -0.50, p < 0.01). Neurological adverse events were generally mild and transient, with gait instability and sensory deficits being the most common.

Conclusion: This meta-analysis demonstrates significant improvements in tremor and neuropsychological outcomes following MRgFUS VIM thalamotomy in TDPD patients, with adverse events being typically mild and transient.

Keywords: Focused ultrasound; Parkinson; Thalamotomy; Tremor; Ventral intermediate.

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References

    1. Bloem BR, Okun MS, Klein eC (2021) Parkinson’s disease. Lancet Lond Engl 397(10291):2284–2303. https://doi.org/10.1016/S0140-6736(21)00218-X
    1. Schapira AHV, Chaudhuri KR, Jenner eP (2017) Non-motor features of Parkinson disease. Nat Rev Neurosci 18(7):435–450. https://doi.org/10.1038/nrn.2017.62
    1. Bond AE et al (2017) Safety and Efficacy of Focused Ultrasound Thalamotomy for Patients With Medication-Refractory, Tremor-Dominant Parkinson Disease: A Randomized Clinical Trial, JAMA Neurol., 74(12):1412–1418, https://doi.org/10.1001/jamaneurol.2017.3098
    1. Marras C (2015) Subtypes of Parkinson’s disease: state of the field and future directions, Curr. Opin. Neurol. 28(4):382–386, ago. https://doi.org/10.1097/WCO.0000000000000219
    1. Armstrong MJ, Okun eMS (2020) Diagnosis and Treatment of Parkinson Disease: A Review, JAMA, 323(6):548–560, fev. https://doi.org/10.1001/jama.2019.22360

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