Focused ultrasound for treatment of movement disorders
Keywords:
Focused ultrasound, movement disordersAbstract
Drug therapy for movement disorders is not always successful and invasive neurosurgical methods are applied for some patients. Stereotactic ablative surgery and deep brain stimulation (DBS) are routinely used, but they both have some limitations and side effects. That’s why less invasive methods are needed. Focused ultrasound (FUS) is increasingly used in the clinical practice for treatment of movement disorders. Focuses ultrasound thalamotomy under MRI control is a noninvasive procedure that decreases the amplitude of hands essential tremor with up to 80%. The intensity of the side effects (sensory and gait disturbances) is maximal during the first week after the intervention due to the perilesional edema. FDA approved in 2016 the treatment of essential tremor with magnetic resonance guided focused ultrasound (MRgFUS) of the brain for ablation of thalamus nucleus ventralis intermedius. MRgFUS of thalamus was approved in 2018 by FDA for treatment of predominantly tremor Parkinson’s disease. The selection of the optimal brain area for treatment of Parkinson’s disease is still under debate, despite of the great experience with DBS and stereotactic lesions.
There is still no existing neuroprotective treatment for Parkinson’s disease, partly because of the inability of most substances to pass through the blood-brain barrier. The low-intensity FUS is able to open the blood-brain barrier, using much less energy than for the ablative procedures. This procedure, combined with ultrasound contrast agent (microbubbles) is extensively investigated for delivery of macromolecules to the brain. These macromolecules (antibodies against alpha-synuclein protein, vectors for gene silencing, enzymes and genes) are not able to pass the blood-brain barrier but are maybe able to modify the course of Parkinson’s disease. Most of the investigations are still in preclinical phase.
In conclusion the focused ultrasound is a new possibility for symptomatic and disease modifying treatment of some movement disorders. The symptomatic treatment with focused ultrasound is minimally invasive and will probable soon replace the routine invasive neurosurgery technics.
References
Alvarez, I., Macias, R., Pavon, N., López, G., Rodríguez-Oroz, M.C., Rodríguez, R., Alvarez, M., Pedroso, I., Teijeiro, J., Fernández, R., Casabona, E., Salazar, S., Maragoto, C., Carballo, M., García, I., Guridi, J., Juncos, J.L., DeLong, M.R., Obeso, J.A. Therapeutic efficacy of unilateral subthalamotomy in Parkinson's disease: results in 89 patients followed for up to 36 months. J. Neurol. Neurosurg. Psychiatry, 2009, 80, 9, 979-985.
Anderson, C., Burchiel, K.J., Hart, M.J., Berk, C., Lou, J.S. A randomized comparison of thalamic stimulation and lesion on self-paced finger movement in essential tremor. Neurosci. Lett., 2009, 462, 166-170.
Blomstedt, P., Hariz, G.M., Hariz, M.I. Pallidotomy versus pallidal stimulation. Parkinsonism Relat. Disord., 2006, 12, 296-301.
Bond, A.E., Shah, B.B., Huss, D.S., Dallapiazza, R.F., Warren, A., Harrison, M.B., Sperling, S.A., Wang, X.Q., Gwinn, R., Witt, J., Ro, S., Elias, W.J. Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial. JAMA Neurol., 2017, 74, 1412-1418.
Chang, W.S., Jung, H.H., Kweon, E.J., Zadicario, E., Rachmilevitch, I., Chang, J.W. Unilateral magnetic resonance guided focused ultrasound thalamotomy for essential tremor: practices and clinicoradiological outcomes. J. Neurol. Neurosurg. Psychiatry, 2015, 86, 257-264.
Cline, H.E., Hynynen, K., Hardy, C.J., Watkins, R.D., Schenck, J.F., Jolesz, F.A. MR temperature mapping of focused ultrasound surgery. Magn. Reson. Med., 1994, 31, 6, 628–636.
Deuschl, G., Raethjen, J., Hellriegel, H., Elble, R. Treatment of patients with essential tremor. Lancet Neurol., 2011, 10, 148-161.
Elias, W.J., Khaled, M., Hilliard, J.D., Aubry, J.F., Frysinger, R.C., Sheehan, J.P., Wintermark, M, Lopes, M.B. A magnetic resonance imaging, histological, and dose modelling comparison of focused ultrasound, radiofrequency, and Gamma Knife radiosurgery lesions in swine thalamus. J. Neurosurg., 2013, 119, 307-317.
Elias, W.J., Lipsman, N., Ondo, W.G., Ghanouni, P., Kim, Y.G., Lee, W., Schwartz, M., Hynynen, K., Lozano, A.M., Shah, B.B., Huss, D., Dallapiazza, R.F., Gwinn, R., Witt, J., Ro, S., Eisenberg, H.M., Fishman, P.S., Gandhi, D., Halpern, C.H., Chuang, R., Pauly, K.B., Tierney, T.S., Hayes, M.T., Cosgrove, G.R., Yamaguchi, T., Abe, K., Taira, T., Chang, J.W. A randomized trial of focused ultrasound thalamotomy for essential tremor. N. Engl. J. Med., 2016, 375, 730-739.
Fasano, A., Linas, M., Munhoz, R.P., Hlasny, E., Kucharczyk, W., Lozano, A.M. MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes. Neurology, 2017, 89, 771-775.
Fishman, P., Lipsman, N. Focused ultrasound as an evolving therapy for Parkinson’s disease. Movement Disorders, 2019, 34, 9, 1241-1242.
Foffani, G., Trigo-Damas, I., Pineda-Pardo, J.A., Blesa, J., Rodríguez-Rojas, R., Martínez-Fernández, R., Obeso, J.A. Focused ultrasound in Parkinson's disease: A twofold path toward disease modification. 2019, 34, 9, 1262-1273.
Fry, W.J., Mosberg, W.H. Jr, Barnard, J.W., Fry, F.J. Production of focal destructive lesions in the central nervous system with ultrasound. J. Neurosurg., 1954, 11, 471-478.
Goldman, M.S., Kelly, P.J. Stereotactic thalamotomy for medically intractable essential tremor. Stereotact. Funct. Neurosurg., 1992, 58, 22-25.
Gross, R.E. What happened to posteroventral pallidotomy for Parkinson’s disease and dystonia. Neurotherapeutics, 2008, 5, 281-293.
Ito, H., Fukutake, S., Yamamoto, K., Yamaguchi, T., Taira, T., Kamei, T. Magnetic resonance imaging-guided focused ultrasound thalamotomy for Parkinson’s disease. Intern. Med., 2018, 57, 7, 1027-1031.
Jung, N.Y., Park, C.K., Kim, M., Lee, P.H., Sohn, Y.H., Chang, J.W. The efficacy and limits of magnetic- resonance-guided focused ultrasound pallidotomy for Parkinson's disease: a phase I clinical trial. J. Neurosurg., 2018.
Karakatsani, M.E, Blesa, J., Konofagou, E.E. Blood-brain-barrier opening with focused ultrasound in experimental model of Parkinson’s disease. Movement Disorders, 2019, 34, 9, 1252-1261.
LeWitt, P.A., Lipsman, N., Kordower, J.H. Focused ultrasound opening of the blood-brain barrier for treatment of Parkinson's disease. Mov. Disord., 2019, 34, 9, 1274-1278.
Martinez-Fernandez, R., Rodriguez-Rojas, R., Del Alamo, M., Hernández-Fernández, F., Pineda-Pardo, J.A., Dileone, M., Alonso-Frech, F., Foffani, G., Obeso, I., Gasca-Salas, C., de Luis-Pastor, E., Vela, L., Obeso, J.A. Focused ultrasound subthalamotomy in patients with asymmetric Parkinson's disease: a pilot study. Lancet Neurol., 2018, 17, 1, 54-63.
Moosa, S., Martinez-Fernandez, R., Elias, J., del Alamo, M., Eisenberg, H.M., Fishman, P.S. The role of high-intensity focused ultrasound as a symptomatic treatment for Parkinson’s disease. Movement Disorders, 2019, 34, 9, 1243-1251.
Price, R.J., Fisher, D.G., Suk, J.S., Hanes, J., Ko, H.S., Kordower, J.H. Parkinson's disease gene therapy: Will focused ultrasound and nanovectors be the next frontier? Mov. Disord., 2019, 34, 9, 1279-1282.
Schlesinger, I., Eran, A., Sinai, A. Erikh, I., Nassar, M., Goldsher, D., Zaaroor, M. MRI guided focused ultrasound thalamotomy for moderate-to-severe tremor in Parkinson’s disease. Parkinsons Dis., 2015, 219149.
Vedam-Mai, V., Bernal, O., Okun, M.S. Overview of surgical treatment possibilities in hyperkinetic disorders. In: Hyperkinetic movement disorders. Differential diagnosis and treatment. Albanese, A., Jankovic, J. eds., Oxford, Wiley-Blackwell, 2012, 49-69.
Wintermark, M., Druzgal, J., Huss, D.S., Khaled, M.A., Monteith, S., Raghavan, P., Huerta, T., Schweickert, L.C., Burkholder, B., Loomba, J.J., Zadicario, E., Qiao, Y., Shah, B., Snell, J., Eames, M., Frysinger, R., Kassell, N., Elias, W.J. Imaging findings in MR imaging-guided focused ultrasound treatment for patients with essential tremor. Am. J. Neuroradiol., 2014, 35, 891-896.
Zesiewicz, T.A., Elble, R., Louis, E.D., Hauser, R.A., Sullivan, K.L., Dewey, R.B Jr., Ondo, W.G., Gronseth, G.S., Weiner, W.J., Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: therapies for essential tremor: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2005, 64, 2008-2020.
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Ivan Milanov
This work is licensed under a Creative Commons Attribution 4.0 International License.
