The focused ultrasound treatment may be an option for patients with medication-refractory tremor-dominant PD. Using advanced technology, neurosurgeons are able to treat deep in the brain with no surgical incisions. Sound waves pass safely through a patient’s skull to heat and precisely ablate (destroy) the target cells in the thalamus; thereby providing a therapeutic effect. During the procedure, a patient lies in an MRI scanner with his/her head in the focused ultrasound helmet. Low energy is first applied allowing the patient to provide feedback of tremor improvement as well as any potential side effects. This feedback allows the treating neurosurgeon to adjust the treatment before high energy is applied to make a final ablation. Many patients show immediate improvement in their tremor. The treatment is continuously guided and monitored using MR imaging. Focused ultrasound procedures are usually performed on an outpatient basis. Patients must be at least 30 years of age.
A randomized, double-blinded study4 was completed with 27 patients to assess the safety and efficacy of focused ultrasound for patients with disabling tremor-dominant PD. The study resulted in significant improvement in tremor that was maintained through a 12-month follow up. The trend in improvement for the focused ultrasound group was also shown in improvements in functional outcome and quality of life measures. Overall, this study showed a very favorable safety profile with 95% of adverse events (AEs) reported as mild or moderate and a majority transient. The most common treatment-related complications included numbness/tingling (7%), imbalance (4%), gait disturbance (2%) and unsteadiness (1%). The number in parenthesis is the percentage of active subjects experiencing these adverse events. There were two serious adverse events (hemiparesis – weakness on one side of the body) reported, one which resolved within one month.4
1https://www.parkinson.org/Understanding-Parkinsons/Statistics 2Grosset, D. (2009). Clinical diagnosis of parkinsonism and tremor. In M. Okun, K. Grosset, H. Fernandez, D. Grosset (Eds.), Parkinson’s Disease: Clinican’s Desk Reference (pp. 33). Boca Raton, Florida: CRC Press. 3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6085452/ 4Pre-Market Approval (PMA) P150038
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