Lesioning procedures for the treatment of Parkinson’s Disease

Is MRI-guided focused ultrasound replacing conventional stereotactic thalamotomy and pallidotomy?

Kelvin L. Chou, MD
Kelvin L. Chou, MD
26th Jan 2024 • 2m read

There are two main ways to perform lesioning procedures—conventionally or using MRI-guided focused ultrasound (FUS).

Here is a quick overview of the different procedures:

Thalamotomy: involves a lesion to the VIM area of the brain. Improves medication-resistant tremors, but does not improve bradykinesia, dyskinesia, or motor fluctuations.

Pallidotomy: involves a lesion to the GPi. Improves dyskinesia, motor fluctuations, tremor, rigidity, and bradykinesia. 

Most patients with Parkinson’s need bilateral treatment because symptoms affect both sides of the body, but bilateral thalamotomy or pallidotomy carries a high risk of speech or swallowing difficulties. Therefore conventional lesioning procedures have mostly been replaced by deep brain stimulation (DBS).

MRI-guided FUS is newer and minimally invasive. Patients have part of their head shaved and then lay down in the MRI machine wearing an ultrasound helmet. MRI is used to visualize the target and the ultrasound helmet is used to focus one thousand ultrasound beams to that target. The patient has repeated rounds of focused ultrasound and is then pulled out of the MRI to test their tremor.

We encourage you to watch the video and this course to learn more about the various treatments for advanced Parkinson’s disease.

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