VIM thalamotomy with MRgFUS in Parkinson's disease:  Efficacy, safety and technique

Raisa Braña Miranda; Francisco Rivera; Nelson Ernesto Quintanal Cordero; Fabián Piedimonte

doi:10.47924/neurotarget2025481

Autores/as

Raisa Braña Miranda Neurology of Central Florida, Research Center. https://orcid.org/0000-0003-0608-7728
Francisco Rivera Fundación CENIT para la Investigación en Neurociencias. Ciudad Autónoma de Buenos Aires. Argentina. https://orcid.org/0009-0005-8979-1906
Nelson Ernesto Quintanal Cordero Fundación CENIT para la Investigación en Neurociencias. Ciudad Autónoma de Buenos Aires. Argentina. https://orcid.org/0000-0003-3812-5899
Fabián Piedimonte Fundación CENIT para la Investigación en Neurociencias. Ciudad Autónoma de Buenos Aires. Argentina. https://orcid.org/0000-0003-4661-4449

DOI:

https://doi.org/10.47924/neurotarget2025481

Palabras clave:

Enfermedad de Parkinson, temblor, talamotomía, VIM, ultrasonido focalizado, MRgFUS

Resumen

Introducción: La talamotomía del núcleo ventral intermedio (VIM) mediante ultrasonido focalizado de alta intensidad guiado por resonancia magnética (MRgFUS) ha emergido como alternativa mínimamente invasiva para el temblor parkinsoniano refractario. Este estudio evalúa la eficacia, seguridad y parámetros técnicos de esta intervención en pacientes con enfermedad de Parkinson.
Métodos: Se realizó una revisión sistemática siguiendo directrices PRISMA. Se incluyeron estudios clínicos que evaluaron MRgFUS dirigido al VIM en enfermedad de Parkinson, con seguimiento mínimo de un mes. Se analizaron variables clínicas (reducción del temblor mediante CRST y MDS-UPDRS III, eventos adversos), técnicas (temperatura máxima, número de sonicaciones, coordenadas estereotácticas) y evolución tecnológica.
Resultados: Once estudios reportaron 97 pacientes tratados. Se observaron reducciones significativas en MDS-UPDRS III de 12.88 puntos a 1 mes, 12.10 a 3 meses, 14.85 a 6 meses y 20.65 a 12 meses en estado "on" medicación. Los efectos adversos fueron mayormente transitorios, incluyendo cefalea, mareos, alteraciones de la marcha y parestesias, con resolución espontánea en la mayoría de casos. Los parámetros técnicos variaron entre estudios, con coordenadas promedio de 6.90-9.08 mm anteriores a PC y 13.11-14.93 mm laterales desde línea media.
Discusión: MRgFUS presenta eficacia sostenida para el control del temblor parkinsoniano con perfil de seguridad favorable comparado con estimulación cerebral profunda. Los avances tecnológicos han optimizado la precisión y reducido complicaciones. La variabilidad en parámetros técnicos refleja la evolución tecnológica y necesidad de la individualización de la focalización del blanco.
Conclusiones: La talamotomía VIM con MRgFUS presenta eficacia sostenida para el control del temblor parkinsoniano con perfil de seguridad favorable comparado con estimulación cerebral profunda. Los avances tecnológicos han optimizado la precisión y reducido complicaciones, consolidando esta técnica como alternativa mínimamente invasiva en pacientes seleccionados.

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