Introduction to MRgFUS for the Treatment of Parkinson
Introduction
Parkinson’s disease (PD) is a complex neurological disorder characterized by the early death of dopaminergic neurons in the substantia nigra pars compacta. The resultant dopamine deficiency within the basal ganglia leads to a movement disorder produced by overactivity of the thalamocortical system. The disorder is characterized by classic parkinsonian motor symptoms, such as tremors, rigidity, and hypobradykinesia. In addition to these motor symptoms, PD is also associated with numerous non-motor symptoms, some of which can occur more than a decade before the onset of motor dysfunction. The prevalence of PD for all ages in Europe ranges from 66 to 1500 per 100,000 people, and its incidence varies from 5 to 26 per 100,000 person-years.
For more detailed informations about PD, it's pathophysiology and the MRgFUS technology, read Section two of the Habilitation – thesis «Incisionless transcranial MR-guided focused ultrasound functional neurosurgery», written by Marc Gallay
What is MRgFUS?
Magnetic Resonance-guided Focused Ultrasound (MRgFUS) represents a revolutionary, incisionless treatment option for chronic, therapy-resistant or therapy-intolerant Parkinson’s Disease (PD). By using ultrasound waves to target and thus modulate brain regions associated with motor as well as some non-motor dysfunctions, MRgFUS offers new possibilities for symptom relief in patients who have exhausted other treatment options.
This technique heats and ablates targeted tissue, creating a small lesion that disrupts the abnormal neural activity responsible for PD symptoms. Unlike traditional surgical interventions, MRgFUS does not require an incision or penetrating the brain, making it a safer, more accurate and less invasive alternative to classical functional neurosurgical approaches.
Source: Insightec Ltd
How It Works
- Targeting Precision: MRI imaging allows for accurate visualization of brain structures, enabling precise focus on areas like the pallidothalamic tract, a key neural pathway implicated in PD.
- Controlled Energy Delivery: Ultrasound energy is applied in a controlled manner to achieve therapeutic effects without damaging surrounding tissues.
- Real-time Monitoring: MR thermometry monitors temperature changes during the procedure to ensure safety and efficacy.
Advantages
- No incision and no penetration: Eliminates risks of infection and significantly reduces the bleeding risk (e.g., 0 > 650 targets performed in the clinic SoniModul).
- No implanted material
- Accuracy in targeting (0.5–1 mm) thanks to the absence of brain penetration (no shift).
- Intraoperative targeting and monitoring options via MRI.
- No general anesthesia required.
- No ionizing radiation used.
MRgFUS can be suitable for patients with advanced, therapy-resistant PD who are either ineligible or reluctant to undergo DBS.
Key Findings from our experience
- Tremor Control: Tremor reductions exceeding 80% have been reported in treated patients, with immediate effects following the procedure.
- Improved Rigidity and Bradykinesia: Rigidity and bradykinesia, two hallmark symptoms of PD, showed reductions of 70% and 73%, respectively, in single-center studies.
- Pain and Sleep Disorders: Up to 89% of patients experienced pain relief, and significant improvements in sleep quality were observed.
- Dyskinesia: Nearly 100% symptom control on the treated body side.
Long-term Benefits
MRgFUS offers durable symptom relief, with studies showing sustained improvements over one year of follow-up. Unlike pharmacological treatments, which may lose effectiveness over time, MRgFUS addresses the underlying neural dysfunctions, providing a more consistent therapeutic outcome. Our retrospective experience with this technique now stretches back more than 10 years.
The Psychoemotional Dimension
Parkinson’s Disease not only affects physical mobility but also has profound psychological and emotional impacts. This emotional dimension must be taken into account in assessments and treated accordingly. For some patients, psychotherapy may be required before MRgFUS can be performed.
Switzerland’s Leadership and the International Context
Switzerland has emerged as a global leader in the development and implementation of MRgFUS, particularly through the pioneering efforts of the SoniModul Center for Ultrasound Functional Neurosurgery. This leadership is rooted in a combination of innovative research and patient care.
Candidacy and Next Steps
MRgFUS is suitable for patients with:
- Advanced PD unresponsive to medication or experiencing side effects.
- Severe tremor, rigidity, or bradykinesia significantly impacting daily life.
- No major cognitive impairments or contraindications for MRI.
How to Proceed
You can contact us either through your treating physician or by sending us a request at
Further reading: Section two of the Habilitation – thesis «Incisionless transcranial MR-guided focused ultrasound functional neurosurgery», written by PD Dr. med. Marc Gallay
Peer-reviewed articles about how we treat Parkinson with the MRgFUS technology: