Unilateral MRI-guided focused ultrasound thalamotomy for moderate to severe tremor in Parkinson’s disease

2.1 Parkinson's disease is a progressive neurodegenerative disease characterised by gradually worsening tremor, muscle rigidity, and difficulties with starting and stopping movements. The tremor in Parkinson's disease occurs at rest and becomes less prominent with voluntary movement. It typically occurs first in the distal upper extremities then moves proximally and spreads to affect other parts of the body over time.

2.2 Treatment for Parkinson's disease includes supportive therapies and medications such as levodopa, dopamine agonists and monoamine oxidase B inhibitors.

2.3 Surgery may be considered in people whose condition has not responded adequately to best medical therapy. Surgical treatments include deep brain stimulation and radiofrequency thalamotomy.

2.4 This procedure is carried out with the patient lying supine inside an MRI scanner. The patient's head is shaved and a stereotactic head frame is attached. Patients are kept awake so they can report any improvement or adverse events to the operator during the procedure. However, they may be offered light sedation. Continuous MRI and thermal mapping are used to identify the target area of the brain and monitor treatment. Low-power (sub-lethal) ultrasound is delivered to confirm the chosen location. Then, high-power focused ultrasound pulses are administered to irreversibly ablate target tissue. Chilled water is circulated around the head during the treatment to prevent thermal damage to the scalp caused by the increase in bone temperature. The procedure takes about 3 hours and symptom relief should be immediate.

2.5 The potential benefits of unilateral MRI-guided focused ultrasound thalamotomy are that it: is less invasive than the other existing procedures; results in a faster recovery time; and allows for testing of the effects of sub-lethal doses before ablation. However, unlike deep brain stimulation it can only be done on 1 side.