Focused Ultrasound and Other Lesioning Therapies in Movement Disorders

Lesioning therapies have been some of the earliest, most effective surgical treatments in movement disorders. This review summarizes recent studies, emerging modalities, and trends in lesioning procedures for movement disorders.

Magnetic resonance-guided high-intensity focused ultrasound (MRgFUS) is the newest incisionless technology for lesioning procedures in movement disorders. It has recent FDA approval for thalamotomy in essential tremor and tremor-dominant Parkinson disease. There are current studies exploring subthalamotomy and pallidotomy in PD. Gamma knife is another incisionless modality that has been studied for decades and remains an effective treatment, albeit with less recent studies and more risks for adverse events, in movement disorders. Radiofrequency lesioning remains an efficacious treatment, particularly for unilateral pallidotomy in PD, but has fallen out of favor compared with other modalities, particularly MRgFUS. Lesioning therapies in movement disorders have shown efficacy in treating a variety of movement disorders. Enthusiasm for their use has waned with the advent of deep brain stimulation. The recent development of MRgFUS has recentered attention on lesioning therapy and its potential. Patient preference and access to care will remain determinants in the use of lesioning therapy as more data are being collected on the long-term benefit and safety.