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MR-guided focused ultrasound offers an incision-free approach to creating a therapeutic lesion in a deep brain target. In this randomized, sham-controlled trial, patients with markedly asymmetric Parkinson disease and medication-incomplete motor control underwent unilateral focused ultrasound subthalamotomy or a sham procedure. At four months, the active-treatment group showed a substantially greater improvement in the motor score of the more affected side than the control group. The study demonstrated proof of efficacy for lesioning the subthalamic nucleus without open cranial surgery. However, adverse effects—including speech disturbance, gait disturbance, weakness and dyskinesia—were observed, and some persisted. The treatment was studied in a carefully selected population rather than in all patients with Parkinson disease. For HCPs, the clinical message is balanced: focused ultrasound is a promising technology for selected patients with asymmetric, medication-refractory motor symptoms, but it does not eliminate the risks of creating a permanent brain lesion. Patient selection, counselling and specialist movement-disorder assessment remain essential. The trial fits the IANCON emphasis on emerging neuromodulation technologies and on matching advanced interventions to the individual clinical phenotype.
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MR-guided focused ultrasound offers an incision-free approach to creating a therapeutic lesion in a deep brain target. In this randomized, sham-controlled trial, patients with markedly asymmetric Parkinson disease and medication-incomplete motor control underwent unilateral focused ultrasound subthalamotomy or a sham procedure. At four months, the active-treatment group showed a substantially greater improvement in the motor score of the more affected side than the control group. The study demonstrated proof of efficacy for lesioning the subthalamic nucleus without open cranial surgery. However, adverse effects—including speech disturbance, gait disturbance, weakness and dyskinesia—were observed, and some persisted. The treatment was studied in a carefully selected population rather than in all patients with Parkinson disease. For HCPs, the clinical message is balanced: focused ultrasound is a promising technology for selected patients with asymmetric, medication-refractory motor symptoms, but it does not eliminate the risks of creating a permanent brain lesion. Patient selection, counselling and specialist movement-disorder assessment remain essential. The trial fits the IANCON emphasis on emerging neuromodulation technologies and on matching advanced interventions to the individual clinical phenotype.
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