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

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    Outcome measures

    The main outcomes include quality of life, tremor, use of antiparkinsonian medicine, neuropsychological outcomes and recurrence of tremor.

    The measures used are detailed in the following paragraphs:

    Quality of life

    This is measured by the Parkinson's Disease Questionnaire, the score of which ranges from 0 to 156. The UPDRS is also used to assess quality of life in people with Parkinson's disease. It consists of: mentation, behaviour and mood (part 1); activities of daily living (part 2); motor examination (part 3); complications of therapy (part 4); modified Hoehn and Yahr staging (part 5); and the Schwab and England scale (part 6). The questions can be answered in the on or off state. Lower scores are better.

    Tremor

    Tremor score can be derived from the Clinical Rating Scale, which ranges from 0 to 32 for tremor in the hand. The CRST part A rates tremor severity from 0 to 4, with 0 being no tremor and 4 being severe tremor. Tremor can also be derived from the UPDRS, which ranges from 0 to 8 for action and rest tremor in the hand. The FTM tremor rating scale is composed of head, voice, rest, postural, and intention tremor of the affected limb. It is graded from 0 to 4 (0 representing no tremor and 4 representing highest tremor severity).

    Use of antiparkinsonian medicine

    Levodopa is a common first-line drug for managing Parkinson's motor symptoms.

    Neuropsychological outcomes:

    The following tests were included as neuropsychological outcome measures:

    • Montreal Cognitive Assessment test

    • Categorical Verbal Fluency test

    • Raven's Progressive Matrices

    • Hamilton Anxiety rating scale

    • Beck Anxiety Inventory (BAI)

    • Beck Depression Inventory-II

    • Parkinson's disease Questionnaire-8.

    MOCA

    Some of the cognitive domains examined in this brief screening tool are attention and concentration, executive functions, memory, language, visuo-constructional skills, conceptual thinking, calculations, and orientation. The MOCA can differentiate healthy cognitive aging from mild cognitive impairment.

    Categorical Verbal Fluency test

    This test explores lexical retrieval and production by asking people to say as many words as possible belonging to the 'colours', 'animals' and 'fruits' categories in 3 different trials, which last 60 seconds each. The final score corresponds to the total number of words produced.

    RPM test

    This test provides a non-verbal estimate of fluid intelligence and reasoning. It measures the problem-solving ability of a person to think logically and solve problems in novel situations, using logical reasoning and regardless of previous knowledge.

    BAI and BDI-II

    These tests investigate the presence of anxiety and depressive feelings.

    PDQ-8

    This 8-item version of the Parkinson's disease questionnaire (PDQ-8) is a shortened version of the 39-item Parkinson's disease questionnaire (PDQ-39) for quality of life.