Interventional procedure overview of MRI-guided focused ultrasound thalamotomy for treating moderate to severe tremor in Parkinson's

Indications and current treatment

Parkinson's is a progressive neurodegenerative condition that damages the brain over many years. It is caused by a loss of the cells in the brain that produce dopamine, which helps to control and coordinate body movements. People with Parkinson's classically present with the symptoms and signs described as 'parkinsonism' these include: bradykinesia (slow movements), rigidity, rest tremor (shaking) and postural instability (loss of balance). In later stages of Parkinson's, other symptoms sometimes described as the 'non-motor' manifestations of Parkinson's such as depression, cognitive impairment, dementia and autonomic disturbances) may be prominent. The condition may progress to cause significant impairments, adversely affecting quality of life and, indirectly, the quality of life of family and carers.

For people with early Parkinson's, drug treatments such as levodopa, other dopamine agonists and monoamine oxidase B inhibitors may be considered. In the later stages, other drugs may be used with levodopa (as adjuvants) to reduce the motor complications associated with prolonged levodopa use. Non-pharmacological management such as, physiotherapy, occupational therapy and speech and language therapy may be considered. Invasive surgical procedures may be considered for people with Parkinson's that is refractory to medical and supportive therapies. These include deep brain stimulation and less commonly radiofrequency thalamotomy. Treatments for non-motor symptoms such as sleep disturbance and depression may also be considered.