Magnetic Resonance Imaging-guided Focused Ultrasound Unilateral Pallidotomy for Parkinsonâs Disease: A Case Report

Unilateral pallidotomy has been accepted as an effective therapeutic option for Parkinson’s disease (PD). We herein report a PD patient with wearing-off and dyskinesia who underwent left globus pallidus internus (GPi) pallidotomy using magnetic resonance imaging-guided focused ultrasound (MRgFUS). Her skull density ratio (SDR) was too low to perform MRgFUS procedure; however, it improved with bisphosphonate. Right-sided wrist rigidity, finger movement, and resting tremor improved immediately following the ultrasound energy delivery. Wearing-off improved and dyskinesia abolished after the procedure. No severe adverse events were observed. MRgFUS is a minimally invasive treatment; however, further investigations concerning not only technical problems such as SDR but also long-term efficacy and safety of this new treatment for PD patients should be necessary.

[1]  M. Hariz,et al.  Seventy years of pallidotomy for movement disorders , 2017 .

[2]  A. Fasano,et al.  Focused Ultrasound for Essential Tremor: Review of the Evidence and Discussion of Current Hurdles , 2017, Tremor and other hyperkinetic movements.

[3]  W. J. Elias,et al.  The emerging role of transcranial magnetic resonance imaging–guided focused ultrasound in functional neurosurgery , 2017, Movement disorders : official journal of the Movement Disorder Society.

[4]  K. Hynynen,et al.  A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. , 2016, The New England journal of medicine.

[5]  Jin Woo Chang,et al.  Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull. , 2016, Journal of neurosurgery.

[6]  Daniel Jeanmonod,et al.  First experience with MR-guided focused ultrasound in the treatment of Parkinson's disease , 2014, Journal of therapeutic ultrasound.

[7]  Regina Katzenschlager,et al.  The Movement Disorder Society Evidence‐Based Medicine Review Update: Treatments for the motor symptoms of Parkinson's disease , 2011, Movement disorders : official journal of the Movement Disorder Society.

[8]  C. Clarke,et al.  Systematic review of levodopa dose equivalency reporting in Parkinson's disease , 2010, Movement disorders : official journal of the Movement Disorder Society.

[9]  Werner Poewe,et al.  Evidence‐based medical review update: Pharmacological and surgical treatments of Parkinson's disease: 2001 to 2004 , 2005, Movement disorders : official journal of the Movement Disorder Society.

[10]  P. Fratzl,et al.  Alendronate increases degree and uniformity of mineralization in cancellous bone and decreases the porosity in cortical bone of osteoporotic women. , 2001, Bone.

[11]  W J FRY,et al.  Production of focal destructive lesions in the central nervous system with ultrasound. , 1954, Journal of neurosurgery.

[12]  Alon Sinai,et al.  Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson's disease and essential tremor cases. , 2018, Journal of neurosurgery.

[13]  E. Zadicario,et al.  Different magnetic resonance imaging patterns after transcranial magnetic resonance-guided focused ultrasound of the ventral intermediate nucleus of the thalamus and anterior limb of the internal capsule in patients with essential tremor or obsessive-compulsive disorder. , 2015, Journal of neurosurgery.

[14]  Lars Michels,et al.  Transcranial magnetic resonance imaging-guided focused ultrasound: noninvasive central lateral thalamotomy for chronic neuropathic pain. , 2012, Neurosurgical focus.