Objective: To assess the safety and efficacy of unilateral focused ultrasound subthalamotomy (FUS-STN) for Parkinson`s disease (PD) 5 years after treatment.

Background: FUS-STN improves cardinal motor signs of PD with a sustained benefit for up to 3 years. Whether this benefit persists beyond this timeframe remains unexplored.

Method: Prospective open-label study of patients with asymmetrical PD who underwent unilateral FUS-STN followed up to 5 years after the procedure. The primary outcome was the difference from baseline to 60 months after FUS-STN in the MDS-UPDRS III (off-med) for the treated side (t.s.). Secondary outcomes were the change in the MDS-UPDRS III (on-med); subscores of rigidity, bradykinesia, tremor; total MDS-UPDRS III; MDS-UPDRS part IV; functional disability (MDS-UPDRS II); quality of life (PDQ39); levodopa equivalent daily dose (LEDD). Adverse events were collected. Non-parametric repeated measures ANOVA was applied for analysis.

Results: Thirty-three patients were included. Among them, 31 were available for the 60-month visit. The mean(±SD) age at baseline was 56.0±10.1 years, with a mean disease duration of 6.8±2.8 years. The MDS-UPDRS III score for the treated side off-med remained improved by 54.5% from baseline to 5 years (from 19.1±3.2 to 8.5±3.8, p<0.001). All cardinal motor features were improved from baseline. No disabling or delayed adverse events were reported. The total MDS-UPDRS III off-med score was 24.8% lower at 5 years than before FUS-STN (from 36.8±7.3 to 26.4±8.8, p=0.043). LEDD was increased after 5 years (from 723.12±258.1 mg to 1090.4±389.9, p<0.001). The MDS-UPDRS IV, II, and PDQ39 scores were equivalent to those at baseline at 5 years.

Conclusion: The effect of unilateral FUS-STN on PD motor features endures at 5 years, contributing to better clinical control over disease evolution. Dopaminergic requirements increase over follow-up due to disease progression. No delayed adverse events occur.

References: Martínez-Fernández, Raúl et al. “Prospective Long-term Follow-up of Focused Ultrasound Unilateral Subthalamotomy for Parkinson Disease.” Neurology vol. 100,13 (2023): e1395-e1405. doi:10.1212/WNL.0000000000206771

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MDS Abstracts - https://www.mdsabstracts.org/abstract/extended-long-term-follow-up-focused-ultrasound-subthalamotomy-in-parkinsons-disease-five-year-prospective-experience/