MR-guided focused ultrasound in movement disorders and beyond: Lessons learned and new frontiers

• Published in: Parkinsonism & related disorders 2024-05, Vol.122, p.106040, Article 106040
• Main Authors: Natera-Villalba, Elena, Ruiz-Yanzi, María-Agustina, Gasca-Salas, Carmen, Matarazzo, Michele, Martínez-Fernández, Raúl
• Format: Article
• Language: English
• Subjects: Dystonia; Essential tremor; Essential Tremor - diagnostic imaging; Essential Tremor - therapy; Focused ultrasound; HIFU; High-Intensity Focused Ultrasound Ablation - methods; Humans; LIFU; Magnetic Resonance Imaging; Movement Disorders - diagnostic imaging; Movement Disorders - therapy; Neuromodulation; Parkinson Disease - diagnostic imaging; Parkinson Disease - therapy; Parkinson's disease; Surgery, Computer-Assisted - methods; Tremor
• ISSN: 1353-8020; 1873-5126; 1873-5126
• DOI: 10.1016/j.parkreldis.2024.106040

The development of MR-guided focused ultrasound (MRgFUS) has provided a new therapeutic tool for neuropsychiatric disorders. In contrast to previously available neurosurgical techniques, MRgFUS allows precise impact on deep brain structures without the need for incision and yields an immediate effect. In its high-intensity modality (MRgHIFU), it produces accurate therapeutic thermoablation in previously selected brain targets. Importantly, the production of the lesion is progressive and highly controlled in real-time by both neuroimaging and clinical means. MRgHIFU ablation is already an accepted and widely used treatment for medically-refractory Parkinson's disease and essential tremor. Notably, other neurological disorders and diverse brain targets, including bilateral treatments, are currently under examination. Conversely, the low-intensity modality (MRgLIFU) shows promising prospects in neuromodulation and transient blood-brain barrier opening (BBBO). In the former circumstance, MRgLIFU could serve as a powerful clinical and research tool for non-invasively modulating brain activity and function. BBBO, on the other hand, emerges as a potentially impactful method to influence disease pathogenesis and progression by increasing brain target engagement of putative therapeutic agents. While promising, these applications remain experimental. As a recently developed technology, MRgFUS is not without challenges and questions to be addressed. Further developments and broader experience are necessary to enhance MRgFUS capabilities in both research and clinical practice, as well as to define device constraints. This clinical mini-review aims to provide an overview of the main evidence of MRgFUS application and to highlight unmet needs and future potentialities of the technique. •Focused ultrasound's (FUS) key advantage lies in impacting deep brain structures without incisions or electrode penetration.•High-intensity FUS is approved globally for Parkinson's Disease (PD) and Essential Tremor (ET).•Bilateral treatment for ET is approved, while investigations for PD are currently ongoing.•Low-intensity FUS has potential applications in neuromodulation and blood-brain barrier opening.•Technical improvements will further amplify the potential of focused ultrasound to enhance patient well-being.