MR-guided ultrasound targets PTT circuit
A new study in the European Journal of Neurology highlights the immediate therapeutic impact of stepwise dual-target MR-guided focused ultrasound (dtMRgFUS) in treating tremor-dominant Parkinson’s disease. This approach targets both the ventral intermediate nucleus (VIM) and the pallidothalamic tract (PTT) in a single session.
Twenty patients (mean age 69.3 ± 8.9 years) with tremor and akinetic rigidity underwent unilateral VIM ablation followed by ipsilateral PTT lesioning while off medication. Primary outcomes included the off-status sub-score of the Unified Parkinson’s Disease Rating Scale part III (UPDRS-III) and the Clinical Rating Scale for Tremor (CRST). Significant improvements in tremor, rigidity, and bradykinesia were observed during the procedure (all p < 0.05, paired t-test). Major motor gains were noted after VIM lesioning (all p < 0.02), with rigidity showing significant improvement only after PTT ablation (p < 0.02).
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These findings highlight the immediate therapeutic impact of PTT lesioning following VIM lesioning in the same treatment session, reinforcing its role as a crucial add-on target for managing refractory PD symptoms beyond tremor. This dtMRgFUS approach offers a more comprehensive motor benefit, particularly for patients with rigidity.
