Safety and efficacy of magnetic resonance imaging-guided focused ultrasound neurosurgery for Parkinson’s disease: a systematic review


Magnetic resonance imaging-guided focused ultrasound (MRgFUS) neurosurgery is a new option for medication-resistant Parkinson’s disease (PD), but its safety and efficacy remain elusive. This study aimed to investigate the safety and efficacy of MRgFUS for PD by systematically reviewing related literature. PubMed and EMBASE were searched to identify related studies. Inclusion criteria were (1) reported the efficacy or safety of MRgFUS for PD and (2) published in English. Exclusion criteria were (1) nonhuman study, (2) review or meta-analysis or other literature types without original data, and (3) conference abstract without full text. Data on study characteristics, treatment parameters, efficacy, and adverse events were collected. Descriptive synthesis of data was performed. Eleven studies containing 80 patients were included. Nine studies were observational studies with no controls. Two studies included a randomized and controlled phase. Most studies included tremor-dominant PD. Ten studies reported decline of UPDRS-III scores after MRgFUS, and five reported a statistically significant decline. Nine studies evaluated the quality of life (QOL). Significant improvement of QOL was reported by four studies using the 39-item Parkinson’s disease questionnaire. Four studies investigated the impact of MRgFUS on non-motor symptoms. Most tests indicated that MRgFUS had no significant effect on neuropsychological outcomes. Most adverse events were mild and transient. MRgFUS is a potential treatment for PD with satisfying efficacy and safety. Studies in this field are still limited. More studies with strict design, larger sample size, and longer follow-up are needed to further investigate its efficacy and safety for PD.

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Fig. 1


  1. 1.

    A Sinai, M Nassar, A Eran, M Constantinescu, M Zaaroor, E Sprecher, I Schlesinger (2019) Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: a 5-year single-center experience. J Neurosurg:1–8

  2. 2.

    Bauer R, Martin E, Haegele-Link S, Kaegi G, von Specht M, Werner B (2014) Noninvasive functional neurosurgery using transcranial MR imaging-guided focused ultrasound. Parkinsonism Relat Disord 20(Suppl 1):S197–S199.

    Article  PubMed  Google Scholar 

  3. 3.

    Bohlhalter S, Kägi G, Kaelin A, Haegele-Link S, Burkhard PR, Pollo C, Schüpbach M, Baumann C, Bassetti CL (2014) Transcranial magnetic resonance imaging-guided focused ultrasound in Parkinson's disease. Schweizer Archiv fur Neurologie und Psychiatrie 165:139–140

    Article  Google Scholar 

  4. 4.

    Bond AE, Shah BB, Huss DS, Dallapiazza RF, Warren A, Harrison MB, Sperling SA, Wang XQ, Gwinn R, Witt J, Ro S, Elias WJ (2017) Safety and efficacy of focused ultrasound thalamotomy for patients with medication-refractory, tremor-dominant Parkinson disease: a randomized clinical trial. JAMA Neurol 74:1412–1418.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Chang WS, Jung HH, Zadicario E, Rachmilevitch I, Tlusty T, Vitek S, Chang JW (2016) Factors associated with successful magnetic resonance–guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull. J Neurosurg 124:411–416.

    Article  PubMed  Google Scholar 

  6. 6.

    Connolly BS, Lang AE (2014) Pharmacological treatment of Parkinson disease: a review. Jama 311:1670–1683.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Elias WJ (2016) A trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 375:2202–2203.

    Article  PubMed  Google Scholar 

  8. 8.

    Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, Schwartz M, Hynynen K, Lozano AM, Shah BB, Huss D, Dallapiazza RF, Gwinn R, Witt J, Ro S, Eisenberg HM, Fishman PS, Gandhi D, Halpern CH, Chuang R, Butts Pauly K, Tierney TS, Hayes MT, Cosgrove GR, Yamaguchi T, Abe K, Taira T, Chang JW (2016) A randomized trial of focused ultrasound thalamotomy for essential tremor. N Engl J Med 375:730–739.

    Article  PubMed  Google Scholar 

  9. 9.

    Fasano A, De Vloo P, Llinas M, Hlasny E, Kucharczyk W, Hamani C, Lozano AM (2018) Magnetic resonance imaging–guided focused ultrasound thalamotomy in Parkinson tremor: reoperation after benefit decay. Movement Disord 33:848–849.

  10. 10.

    Fasano A, Llinas M, Munhoz RP, Hlasny E, Kucharczyk W, Lozano AM (2017) MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes. Neurology 89:771–775.

    Article  PubMed  Google Scholar 

  11. 11.

    Gallay MN, Moser D, Jeanmonod D (2018) Safety and accuracy of incisionless transcranial MR-guided focused ultrasound functional neurosurgery: single-center experience with 253 targets in 180 treatments. J Neurosurg:1–10.

  12. 12.

    H N, F Y, Y N (1984) Levodopa-induced dyskinesia and thalamotomy. J Neurol Neurosurg Psychiatry 47:831–839

  13. 13.

    Hamani C, Lozano AM (2006) Hardware-related complications of deep brain stimulation: a review of the published literature. Stereotact Funct Neurosurg 84:248–251.

    Article  PubMed  Google Scholar 

  14. 14.

    Harary M, Segar DJ, Huang KT, Tafel IJ, Valdes PA, Cosgrove GR (2018) Focused ultrasound in neurosurgery: a historical perspective. Neurosurg Focus 44:E2.

    Article  PubMed  Google Scholar 

  15. 15.

    Hariz MI, Rehncrona S, Quinn NP, Speelman JD, Wensing C (2008) Multicenter study on deep brain stimulation in Parkinson’s disease: an independent assessment of reported adverse events at 4 years. Movement Disord 23(3):416–421.

  16. 16.

    Iacopino DG, Gagliardo C, Giugno A, Giammalva GR, Napoli A, Maugeri R, Graziano F, Valentino F, Cosentino G, D'Amelio M, Bartolotta TV, Catalano C, Fierro B, Midiri M, Lagalla R (2018) Preliminary experience with a transcranial magnetic resonance-guided focused ultrasound surgery system integrated with a 1.5-T MRI unit in a series of patients with essential tremor and Parkinson’s disease. Neurosurg Focus 44:E7.

    Article  PubMed  Google Scholar 

  17. 17.

    Ito H, Fukutake S, Yamamoto K, Tanaka S, Yamaguchi T, Taira T, Kamei T (2018) Magnetic resonance imaging-guided focused ultrasound thalamotomy for Parkinson’s disease with cardiac pacemaker: a case report. Mov Disord Clin Pract 5:339–340.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Ito H, Fukutake S, Yamamoto K, Yamaguchi T, Taira T, Kamei T (2018) Magnetic resonance imaging-guided focused ultrasound thalamotomy for Parkinson’s disease. Intern Med 57:1027–1031.

    Article  PubMed  Google Scholar 

  19. 19.

    Klein JC, Barbe MT, Seifried C, Baudrexel S, Runge M, Maarouf M, Gasser T, Hattingen E, Leibig T, Deichmann R, Timmermann L, Weise L, Hilker R (2012) The tremor network targeted by successful VIM deep brain stimulation in humans. Neurology 78:787–795

    CAS  Article  Google Scholar 

  20. 20.

    Jung NY, Park CK, Kim M, Lee PH, Sohn YH, Chang JW (2018) The efficacy and limits of magnetic resonance-guided focused ultrasound pallidotomy for Parkinson's disease: a Phase I clinical trial. J Neurosurg:1–9.

  21. 21.

    Kalia LV, Lang AE (2015) Parkinson's disease. Lancet 386:896–912.

    CAS  Article  Google Scholar 

  22. 22.

    Kinfe TM (2017) Stereotactic MR-guided focused ultrasound deep brain lesioning: the resurrection of posteroventral pallidotomy and thalamotomy for Parkinson’s disease? Acta Neurochir 159:1367–1369.

    Article  PubMed  Google Scholar 

  23. 23.

    Lozano AM (2000) Vim thalamic stimulation for tremor. Arch Med Res 31:266–269

    CAS  Article  Google Scholar 

  24. 24.

    D’Souza M, Chen KS, Rosenberg J, Elias WJ, Eisenberg HM, Gwinn R, Taira T, Chang JW, Lipsman N, Krishna V, Igase K, Yamada K, Kishima H, Cosgrove R, Rumià J, Kaplitt MG, Hirabayashi H, Nandi D, Henderson JM, Butts Pauly K, Dayan M, Halpern CH, Ghanouni P (2019) Impact of skull density ratio on efficacy and safety of magnetic resonance-guided focused ultrasound treatment of essential tremor. J Neurosurg:1–6

  25. 25.

    Magara A, Bühler R, Moser D, Kowalski M, Pourtehrani P, Jeanmonod D (2014) First experience with MR-guided focused ultrasound in the treatment of Parkinson’s disease. J Ther Ultrasound:2.

  26. 26.

    Martínez-Fernández R, Rodríguez-Rojas R, del Álamo M, Hernández-Fernández F, Pineda-Pardo JA, Dileone M, Alonso-Frech F, Foffani G, Obeso I, Gasca-Salas C, de Luis-Pastor E, Vela L, Obeso JA (2018) Focused ultrasound subthalamotomy in patients with asymmetric Parkinson's disease: a pilot study. Lancet Neurol 17:54–63.

    Article  PubMed  Google Scholar 

  27. 27.

    Meng Y, Solomon B, Boutet A, Llinas M, Scantlebury N, Huang Y, Hynynen K, Hamani C, Fasano A, Lozano AM, Lipsman N, Schwartz ML (2018) Magnetic resonance-guided focused ultrasound thalamotomy for treatment of essential tremor: a 2-year outcome study. Mov Disord 33:1647–1650.

    Article  PubMed  Google Scholar 

  28. 28.

    Meng Y, Voisin MR, Suppiah S, Kalia SK, Kalia LV, Hamani C, Lipsman N (2018) Is there a role for MR-guided focused ultrasound in Parkinson’s disease? Movement Disord 33:575–579.

  29. 29.

    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8:336–341.

    Article  Google Scholar 

  30. 30.

    Moser D, Zadicario E, Schiff G, Jeanmonod D (2013) MR-guided focused ultrasound technique in functional neurosurgery: targeting accuracy. J Ther Ultrasound 1:3.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Na YC, Chang WS, Jung HH, Kweon EJ, Chang JW (2015) Unilateral magnetic resonance-guided focused ultrasound pallidotomy for Parkinson disease. Neurology 85:549–551.

    Article  PubMed  Google Scholar 

  32. 32.

    Pringsheim T, Jette N, Frolkis A, Steeves TD (2014) The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Movement Disord 29:1583–1590.

  33. 33.

    Ramirez-Zamora A, Ostrem JL (2018) Globus Pallidus Interna or subthalamic nucleus deep brain stimulation for Parkinson disease: a review. JAMA Neurol 75:367–372.

    Article  PubMed  Google Scholar 

  34. 34.

    Ravikumar VK, Parker JJ, Hornbeck TS, Santini VE, Pauly KB, Wintermark M, Ghanouni P, Stein SC, Halpern CH (2017) Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor. Movement Disord 32:1165–1173.

  35. 35.

    Schlesinger I, Eran A, Sinai A, Erikh I, Nassar M, Goldsher D, Zaaroor M (2015) MRI guided focused ultrasound thalamotomy for moderate-to-severe tremor in Parkinson’s disease. Parkinson’s Dis 2015.

  36. 36.

    Schlesinger I, Sinai A, Zaaroor M (2017) MRI-guided focused ultrasound in Parkinson’s disease: a review. Parkinson’s Dis 2017.

  37. 37.

    Slim K, Nini E, Forestier D, Kwiatkowski F, Chipponi J (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716

    Article  Google Scholar 

  38. 38.

    Sperling SA, Shah BB, Barrett MJ, Bond AE, Huss DS, Gonzalez Mejia JA, Elias WJ (2018) Focused ultrasound thalamotomy in Parkinson disease: nonmotor outcomes and quality of life. Neurology 91:e1275–e1284.

    Article  PubMed  Google Scholar 

  39. 39.

    Oderken VJ, Boel JA, Schmand BA, de Haan RJ, Figee M, van den Munckhof P, Schuurman PR, de Bie RM (2016) GPi vs STN deep brain stimulation for Parkinson disease: three-year follow-up. Neurology 86:755–761

    Article  Google Scholar 

  40. 40.

    Park YS, Jung NY, Na YC, Chang JW (2019) Four-year follow-up results of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor. Movement Disord 34:727–734

  41. 41.

    Zaaroor M, Sinai A, Goldsher D, Eran A, Nassar M, Schlesinger I (2018) Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson’s disease and essential tremor cases. J Neurosurg 128:202–210.

    Article  PubMed  Google Scholar 

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This work was funded by the National Natural Science Foundation of China (81870999) and 135 Project of Outstanding Development of West China Hospital, Sichuan University (ZY2017307).

Author information




YX, QH, and WW proposed the conception and design of the study. YX and QH conducted the literature search, study screening, data extraction, and quality assessment. All authors were involved in the analysis and interpretation of data. YX drafted the manuscript and all authors revised it critically under the guidance of WW. All authors have approved the final version of the manuscript to be submitted.

Corresponding author

Correspondence to Wei Wang.

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The authors declare that they have no conflict of interest.

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This study was approved by West China Hospital of Sichuan University Biomedical Research Ethics Committee.

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The nature of this study did not require informed consent.

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Xu, Y., He, Q., Wang, M. et al. Safety and efficacy of magnetic resonance imaging-guided focused ultrasound neurosurgery for Parkinson’s disease: a systematic review. Neurosurg Rev 44, 115–127 (2021).

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  • Parkinson’s disease
  • Magnetic resonance imaging-guided focused ultrasound
  • Systematic review
  • Safety
  • Efficacy