MRI-guided focused ultrasound thalamotomy for treating moderate to severe tremor in 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 9 sources, which was discussed by the committee. The evidence included 6 case series, 1 randomised controlled trial (reported in 2 papers) and 1 systematic review. 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: reduction in tremor, quality of life, use of antiparkinsonian medicine and recurrence of tremor.

The professional experts and the committee considered the key safety outcomes to be: head discomfort or pain, vestibular symptoms (dizziness or vertigo), paraesthesia or numbness, taste, gait disturbance, hand ataxia, dysarthria, asthenia and vocal change.

Patient commentary was sought but none was received.

This procedure has the potential to eliminate tremor in people with Parkinson's, which could have a significant benefit for activities of daily living.

The committee noted the ability to control the position and size of the lesion in real time.

The committee noted that this procedure is used for treating tremor but does not treat other components of Parkinson's. Only a small proportion of people with Parkinson's have tremor as the dominant feature.

The procedure is done unilaterally rather than as a bilateral treatment for safety reasons.

A prospective data collection registry would be useful, particularly for capturing longer-term safety outcomes.