MRI-guided focused ultrasound subthalamotomy for treating Parkinson's

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 4 sources, which was discussed by the committee. The evidence included 1 RCT and 3 prospective studies. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: improvement in motor features, functional improvement in activities of daily living, reduction in the use of antiparkinsonian medicine, quality of life and patient satisfaction.

The professional experts and the committee considered the key safety outcomes to be: speech problems, gait problems, new onset dyskinesia, facial asymmetry, pins and needles, and weakness on the treated side.

Patient commentary was sought but none was received.

The procedure is used to treat unilateral symptoms of Parkinson's. 

Targeting the subthalamic nucleus is designed to treat motor symptoms of Parkinson's including tremor. But a high incidence of undesirable neurological side effects, which may be permanent, have been reported in the literature.

The procedure may have an advantage over surgical and other minimally invasive procedures because it can create a more controlled lesion with real-time monitoring and testing. 

The procedure may have a role when a more invasive procedure, such as deep brain stimulation of the subthalamic nucleus, is indicated but is not suitable.