Guidance

1 Recommendations

1 Recommendations

1.1

More research is needed on MRI-guided focused ultrasound thalamotomy for treating moderate to severe tremor in Parkinson's before it can be used in the NHS.

1.2

This procedure should only be done as part of a formal research study and a research ethics committee needs to have approved its use.

What research is needed

1.3

More research is needed on:

  • patient selection (including the severity of Parkinson's and impact of tremor)

  • the technique used

  • safety outcomes

  • longer-term efficacy outcomes.

1.4

Patient selection should be done by a movement disorders multidisciplinary team experienced in managing the condition. The procedure should only be done by a multidisciplinary team including a neurosurgeon with specialist expertise in the procedure.

Why the committee made these recommendations

There is little good-quality evidence for this procedure. The evidence is mainly from observational studies and suggests that people who have the procedure have fewer and less severe tremors. A potential benefit is that the tremor reduction can be seen and controlled during the procedure. Some people who cannot have deep brain stimulation may particularly benefit from this procedure. But more evidence is needed.

There are reports of complications and long-term research with more people is needed to understand the longer-term outcomes of the procedure. So it can only be used in research.