Simultaneous dual-target magnetic resonance-guided focused ultrasound treatment for patients with tremor-dominant Parkinson’s disease

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Abstract

Introduction. Non-invasive magnetic resonance-guided focused ultrasound (MRgFUS) is a new neurosurgical treatment option for tremor-dominant Parkinson’s disease (TDPD). Outcomes of ablation with dual targeting of two subcortical nuclei to improve functional treatment results are yet to be explored.

Aim. This study aimed to evaluate the safety and efficacy of MRgFUS with simultaneous unilateral ablation of two cerebral targets in patients with TDPD.

Materials and methods. A total of 82 TDPD patients (20 women, 62 men; median age 65.0 [52.5; 70,0] years) received unilateral MRgFUS, i.e. ventrointermedial (VIM) nucleus thalamotomy and/or pallidothalamotractotomy (PTT). Motor symptoms, including tremor, were assessed using MDS-Unified Parkinson’s Disease Rating Scale Part III (MDS-UPDRS-III). VIM, PTT, and VIM + PTT ablation was received by 34, 12, and 36 patients, respectively.

Results. After surgery, MDS-UPDRS-III score improved by 40.1% (30.2; 51.7) without early or late-onset serious complications. Tremor returned in 18 patients (all after VIM thalamotomy); 9 of them successfully underwent re-treatment 9–12 months after the first procedure. Simultaneous dual-target (VIM + PPT) intervention was successfully received by 36 patients without any serious complications. A total of 89.3% and 69.7% of patients remained relapse-free in the dual-target and single-target groups, respectively (p = 0.039).

Conclusion. Simultaneous dual-target (VIM and PTT) MRgFUS showed favorable safety and efficacy profiles and can be considered a symptomatic treatment option for TDPD patients.

About the authors

Rezida M. Galimova

Bashkir State Medical University; Intellectual Neurosurgery Clinic, V.S. Buzaev International Medical Center

Author for correspondence.
Email: rezida@galimova.com
ORCID iD: 0000-0003-2758-0351

Cand. Sci. (Med.), Department of neurosurgery, Bashkir State Medical University; chief, neurosurgeon, Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Russian Federation, Ufa; Ufa

Sergey N. Illarioshkin

Research Center of Neurology

Email: annaly-nevrologii@neurology.ru
ORCID iD: 0000-0002-2704-6282

D. Sci. (Med.), Prof., RAS Full Member, Director, Brain Institute, Deputy director, Research Center of Neurology

Russian Federation, Moscow

Gulnara N. Akhmadeeva

Bashkir State Medical University; Intellectual Neurosurgery Clinic, V.S. Buzaev International Medical Center

Email: nevrolog.ufa@gmail.com
ORCID iD: 0000-0001-5516-0587

Cand. Sci. (Med.), Department of neurology, Bashkir State Medical University; neurologist, Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Russian Federation, Ufa; Ufa

Dinara I. Nabiullina

Intellectual Neurosurgery Clinic, V.S. Buzaev International Medical Center

Email: Nabiullina.Dinara@yandex.ru
ORCID iD: 0000-0003-2570-3709

neurologist, Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Russian Federation, Ufa

Felix F. Kashapov

Intellectual Neurosurgery Clinic, V.S. Buzaev International Medical Center

Email: felix.kashapov@mail.ru
ORCID iD: 0000-0003-3355-4096

neurologist, Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Russian Federation, Ufa

Shamil M. Safin

Bashkir State Medical University

Email: safinsh@mail.ru
ORCID iD: 0000-0002-0100-6100

D. Sci. (Med.), Prof., Head, Department of neurosurgery, Bashkir State Medical University

Russian Federation, Ufa

Igor V. Buzaev

Bashkir State Medical University; Intellectual Neurosurgery Clinic, V.S. Buzaev International Medical Center

Email: igor@buzaev.com
ORCID iD: 0000-0003-0511-9345

D. Sci. (Med.), Prof., Surgery department, Bashkir State Medical University; cardiovascular surgeon, Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Russian Federation, Ufa; Ufa

Dinara R. Teregulova

Intellectual Neurosurgery Clinic, V.S. Buzaev International Medical Center

Email: dinamail@mail.ru
ORCID iD: 0000-0001-6283-3735

Cand. Sci. (Med.), neurologist, Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Russian Federation, Ufa

Yulia A. Sidorova

Intellectual Neurosurgery Clinic, V.S. Buzaev International Medical Center

Email: yuliasi.ufa@gmail.com
ORCID iD: 0000-0002-0992-0239

neurologist, Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Russian Federation, Ufa

Olga V. Kachemaeva

Bashkir State Medical University; Intellectual Neurosurgery Clinic, V.S. Buzaev International Medical Center

Email: olga.kachemaeva@gmail.com
ORCID iD: 0000-0001-9949-9582

Cand. Sci. (Med.), Associate Professor, Department of neurology, Bashkir State Medical University; neurologist, Intelligent Neurosurgery Clinic, International Medical Center V.S. Buzaev Memorial

Russian Federation, Ufa; Ufa

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Supplementary files

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2. Fig. 1. MRgFUS treatment response (scores) in TDPD patients.

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3. Fig. 2. Percentage improvement achieved in TDPD patients after MRgFUS (MDS-UPDRS, part III) vs. baseline by different targets.

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4. Fig. 3. Patient’s MRI scan 2 h after simultaneous right-sided PTT + VIM ablation (axial and coronary planes).

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5. Fig. 4. Kaplan–Meier curve for symptom return depending on PTT targeting.

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Copyright (c) 2024 Galimova R.M., Illarioshkin S.N., Akhmadeeva G.N., Nabiullina D.I., Kashapov F.F., Safin S.M., Buzaev I.V., Teregulova D.R., Sidorova Y.A., Kachemaeva O.V.

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