Interventional procedure overview of MRI-guided focused ultrasound subthalamotomy for treating Parkinson's

Existing assessments of this procedure

The treatment guidelines on Parkinson's (invasive therapies) by the European Academy of Neurology and the European section of the Movement Disorder Society recommend 'using unilateral MRgFUS of the STN in people with distinctly unilateral PD only within clinical studies or registries due to the limited data on this new treatment'.

The guidelines task force considered that 'this treatment is new, and only one RCT is available. The results are promising regarding the standard outcomes for advanced PD. The adverse events are frequent, but longer-term sequela are mild and rare. Many key questions, however, remain open regarding this treatment: Long-term data beyond 1 year are lacking. The treatment was applied unilaterally in a highly selected group of people with unilaterally dominant PD. Therefore, preliminary data suggesting that MRgFUS may be cost-effective compared with DBS should be interpreted with caution. The majority of people with advanced PD have bilateral disease, but it is unknown whether MRgFUS subthalamotomy can be safely and efficiently performed bilaterally. Despite initial promising results, currently the treatment cannot be recommended outside clinical studies' (Deuschl G 2022).

The multidisciplinary consensus paper for safe implementation and standardized practice of MRgHiFUS treatments for functional neurosurgery in Switzerland states that 'good clinical evidence is presently only available for unilateral thalamic lesioning in treating essential tremor or tremor-dominant Parkinson's disease and, to a minor extent, for unilateral subthalamotomy for Parkinson's disease motor features. However, the workgroup unequivocally recommends further exploration and adaptation of MRgHiFUS-based functional lesioning interventions and confirms the need for outcome-based evaluation of these approaches based on a unified registry. MRgHiFUS and DBS should be evaluated by experts familiar with both methods, as they are mutually complementing therapy options to be appreciated for their distinct advantages and potential' (Stieglitz LH 2021).