Objective: To report first results of a study monitoring speech and swallowing function after lesional functional neurosurgery for movement disorders.

Background: Transcranial MR-guided high intensity focused ultrasound (tcMRgFUS) allows ablation of deep brain structures without affecting surrounding tissue. Dysphagia and dysarthria have been described following pallidotomy and subthalamotomy but comprehensive swallowing assessments including instrumental testing (Fiberoptic Endoscopic Evaluation of Swallowing, FEES) as one of the gold standards are lacking.

Methods: Prospective, open label observational study of swallowing and speech after unilateral tcMRgFUS ablation within the pallidothalamic tract (PTT) or cerebellothalamic tract (CTT) in patients with Parkinson’s disease (PD) and Essential tremor (ET). Unilateral ablation of the PTT (in PD) or CTT (in ET) was done with the ExAblate Neurosystem (InSightec Israel). The lesion could be objectified in MR sequences. Procedures consisted of a comprehensive clinical assessment by the speech and swallowing specialists including instrumental testing (FEES by video recording) before and 6 months after intervention. Dysphagia was graded using the Penetration-Aspiration Scale ranging from 1 (no penetration) to 8 (aspiration). Speech intelligibility was graded using the speech intelligibility rating scale (SIRS) ranging from 1 (no intelligibility) to 5 (normal intelligibility).

Results: 3 PD (1 m, 65y ±12) and 6 ET patients (2 m, 71y ± 8) received unilateral tcMRgFUS ablation. None of the patients reported dysphagia and clinical assessment remained unchanged with an aspiration-penetration score of 1 at baseline and at follow up. Swallowing assessment 24 months after intervention of one patient with bilateral PTT ablation was normal (score 1). Speech intelligibility remained normal (SIRS 1) after treatment in all patients. The PD patient with bilateral treatment progressed from SIRS 3 (baseline) to SIRS 2 (24 months). In PD patients the mean UPDRS III score improved from 32.5 ± 12.5 at baseline to 8.7 ± 4.4 after 6 months. In ET patients, tremor of the treated hand was improved by 84.3% (Fahn Tolosa Marin Score).

Conclusions: Unilateral tcMRgFUS ablation of the PTT in PD patients or CTT in ET patients seems to be safe regarding dysphagia and dysarthria and highly effective regarding motor improvement.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transcranial-unilateral-mr-guided-high-intensity-focused-ultrasound-in-parkinsons-disease-or-essential-tremor-seems-to-be-save-concerning-dysphagia-and-dysarthria/