Long-term effect of unilateral subthalamotomy for Parkinson’s disease

Prospective Long-term Follow-up of Focused Ultrasound Unilateral Subthalamotomy for Parkinson Disease

“…This fits well with previous results of radiofrequency-induced subthalamotomy. 17-20 The favorable outcome we have observed regarding dyskinesia may also be mediated by the intended extension of the lesion into the dorsomedial subthalamic area to affect the pallidothalamic tract, which has been shown to reduce the likelihood of hemichorea-ballism. 12,21…”

“…Several series have shown the sustained benefit of radiofrequency-induced thalamotomy for essential and parkinsonian tremor 22,23 and pallidotomy and subthalamotomy in PD. 18,19,24 FUS and radiofrequency ablations are induced differently but essentially share the same therapeutic mechanism (i.e., heating-mediated elimination of brain targets where neuronal activity is abnormal), and the MRI features of lesions produced by either technique are comparable. Thus, an equivalent effect of both methods in the long term could be anticipated.…”

The Apparent Impunity of the Basal Ganglia to Therapeutic Lesioning: Clinical and Scientific Lessons

“…Currently, it is known that lesions of the STN and GPi as well as the ventrolateral nucleus of the thalamus (VLo‐pallidal receiving area) as carried out with FUS are therapeutically beneficial with no obvious clinical deficits, aside from possible adverse events related to erroneous targeting. Similar to the effect of deep brain stimulation (DBS), the clinical benefit from subthalamotomy, pallidotomy and thalamotomy on PD motor features can be sustained in the long term 22,23 . Certainly, the clinical response is somewhat variable, mainly related to specific individual factors (eg, the accuracy and precision and total volume of the lesion) but also differences in disease progression.…”

The Role of Focused Ultrasound in the Management of Movement Disorders: Insights after 5 Years of Experience

“…Of note, long-term experience with surgical radiofrequency lesions shows that eventual levodopa increases required by disease progression can be applied without significant complications (such as levodopa-induced dyskinesia) in the previously treated body side. [32][33][34] Whether or not bilateral ultrasound ablation for PD (at any target) can be safely performed still needs to be tested. Studies with radiofrequency surgical Video 1.…”

“…Anyhow, while the unilaterality of FUS ablation for PD could be considered a limitation, many patients remain little affected in one body side for several years. Of note, long‐term experience with surgical radiofrequency lesions shows that eventual levodopa increases required by disease progression can be applied without significant complications (such as levodopa‐induced dyskinesia) in the previously treated body side 32–34 . Whether or not bilateral ultrasound ablation for PD (at any target) can be safely performed still needs to be tested.…”