Objective: The experience we performed the first tremor-dominant Parkinson’s disease treatment using MR-guided focused ultrasound in Taiwan to relief resting tremor of hand.

Background: There were about 50% of patients diagnosed with Parkinson’s disease also suffering from tremor. Tremor bothers their daily life, work and their confidence. Using medication to control their tremor usually have little or partial effects, operations would be another choice to relieve the symptom. Comparing to operations like Deep Brain Stimulation or Gamma-Knife, MR-guided focused ultrasound demonstrates a potential to provides a minimum invasive surgical approach to effectively improve the symptoms on different indications, including on tremor control of Parkinson’s disease.

Method: A 67 years old male who was diagnosed with tremor-dominant Parkinson’s disease had left hand resting tremor interrupting his daily life. After received behavioral evaluation and imaging study for screening, inclusive of MDS-UPDRS, Clinical Rating Scale of Tremor, 25 mCi Tc99m-ECD SPECT, 30 mCi Tc99m-TRODAT SPECT, MRI and CT, he was informed and recruited to receive the MR-guided focused ultrasound thalamotomy. During the procedure, right side ventral-intermediate nuclei (VIM) in the thalamus was targeted to mitigate the resting tremor of left hand.

Results: The highest averaged temperature achieved during the MR-guided focused ultrasound thalamotomy was 59 degrees. The resting tremor symptom of the left hand was relieved right after the MR-guided focused ultrasound thalamotomy. Score decline could also be seen in Clinical Rating Scale of Tremor and the motor part of MDS-UPDRS. The MR images one-day after the treatment revealed an 8x6x9 mm lesion at the right side of the thalamus with the damage of the other brain tissue. The SWAN image showed a focal bleeding at the lesion side. The tractography revealed by DTI suggested a neuro-fiber blocking from the treated target compared to the contralateral side.

Conclusion: The immediate symptom relief suggested the efficiency and safety of this MR-guided focused ultrasound to control the tremor-dominant Parkinson’s disease. In December last year, FDA just approved this surgical approach to control the tremor for the Parkinson’s disease. We can look forward to hearing the Taiwan FDA to approve this indication with MR-guided focused ultrasound to help more patient in our society.

References: Helmich, R. C., Hallett, M., Deuschl, G., Toni, I., & Bloem, B. R. (2012). Cerebral causes and consequences of parkinsonian resting tremor: a tale of two circuits?. Brain : a journal of neurology, 135(Pt 11), 3206-26. Zaaroor, Menashe & Sinai, Alon & Goldsher, Dorith & Eran, Ayelet & Nassar, Maria & Schlesinger, Ilana. (2017). Magnetic resonance-guided focused ultrasound thalamotomy for tremor: A report of 30 Parkinson’s disease and essential tremor cases. Journal of Neurosurgery. 128. 1-9. 10.3171/2016.10.JNS16758.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-first-tremor-dominant-parkinsons-disease-treatment-in-taiwan-using-mr-guided-focused-ultrasound/