Ultrasound Ablation Benefits Motor Function, Reduces Dyskinesia in Patients With Parkinson Disease

Patients with Parkinson disease experienced improved motor and dyskinesia symptoms 3 months after undergoing unilateral ultrasound ablation of the internal segment of globus pallidus, although reported adverse events included dysarthria and gait disturbance. Researchers published their study in The New England Journal of Medicine. 

Encouraged by previous open-label studies that have found motor symptom improvement after unilateral pallidal ultrasound ablation, investigators randomized 94 patients in the off-medication state 3:1 to either focused ultrasound ablation opposite the most symptomatic side of the body or a sham procedure. The first 3 months of the trial were blinded. Afterward, an open-label phase continued until 12 months. 

According to the study, 3-month response rates were 69% for patients who received the active procedure compared with 32% in the control group. Of the 45 responders in the active treatment group, 19 patients improved 3 or more points on the Movement Disorders Society–Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS III) for the treated side in the off-medication state, 8 patients improved 3 or more points on the Unified Dyskinesia Rating Scale in the on-medication state, and 18 patients did both.

Among 39 patients who had a 3-month response with active treatment and were assessed at 12 months, 30 patients showed a continued response, the study found. 

In addition to dysarthria and gait disturbance, other pallidotomy-related adverse events with active treatment were loss of taste, visual disturbance, and facial weakness.

“Longer and larger trials are required to determine the effect and safety of this technique in persons with Parkinson’s disease,” advised corresponding author Howard M Eisenberg, MD, of the University of Maryland School of Medicine in Baltimore, and coauthors.

Reference: 
Krishna V, Fishman PS, Eisenberg HM, et al. Trial of globus pallidus focused ultrasound ablation in Parkinson’s disease. N Engl J Med. 2023;388(8):683-693. doi:10.1056/NEJMoa2202721