Objective: To present two patients of Parkinson’s disease (PD) with Magnetic resonance imaging-guided focused ultrasound (MRgFUS) unilateral pallidotomy.

Background: MRgFUS is a new technology that enables minimum intracranial focal ablation and unilateral pallidotomy has been accepted as an effective therapeutic option for PD. We herein report two PD patients with motor-fluctuations who underwent MRgFUS left globus pallidus internus (GPi) pallidotomy.

Methods: Patient 1 was a 78-year-old, right-handed woman with a 15-year history of PD presented with medication-resistant wearing-off and dyskinesia. Patient 2 was a 70-year-old, right-handed woman with a 6-year history of PD presented medication-resistant wearing-off and dyskinesia. Both of them refused other neurosurgical or radiological procedures involving deep brain stimulation and desired MRgFUS unilateral GPi pallidotomy. Following Institutional Review Board approval, we obtained written informed consent in accordance with the Declaration of Helsinki. We performed MRgFUS GPi pallidotomy using 1.5-Tesla MRI (Signa HDx, GE Healthcare, USA) and a focused ultrasound system (ExAblate 4000, InSightec, Israel).

Results: MDS-UPDRS part Ⅲ scores reduced over 12 weeks after the procedure (Patient 1: 94.7% on medication and 69.7% off medication; Patient 2: 71.4% on medication and 63.6% off medication). Furthermore, dyskinesia abolished in patient 1 over 12 weeks after the procedure. No serious adverse events occurred during and after the procedure.

Conclusions: MRgFUS GPi pallidotomy might become a viable therapeutic option for PD patients with medication-refractory motor fluctuation.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/magnetic-resonance-imaging-guided-focused-ultrasound-unilateral-pallidotomy-for-parkinsons-disease-a-report-of-2-patients/