Efficacy and Safety of Unilateral Subthalamotomy Using Magnetic Resonance-Guided Focused Ultrasound in Parkinson’s Disease: A Systematic Review

Abstract

Introduction: Parkinson's disease often progresses to medication-refractory motor complications. While DBS-STN is highly effective, its invasive nature limits accessibility. MRgFUS-STN has emerged as a non-invasive alternative. This systematic review evaluates the efficacy and safety of MRgFUS-STN in PD management.
Methods: Systematic review of studies (2014-2024) following PRISMA guidelines. Databases searched included PubMed, Embase, and Cochrane Library. Included studies: randomized trials, prospective cohorts, and case series (n≥10) evaluating MRgFUS-STN. Primary outcomes: MDS-UPDRS III changes and safety profiles.
Results: Twenty studies (258 patients) met inclusion criteria. Meta-analysis showed significant MDS-UPDRS III reductions in off-medication states (-13.8 points, 95% CI: -16.2 to -11.4, p<0.001). A randomized trial demonstrated 52.6% improvement versus 8% in controls (p<0.001). Component analysis revealed 83.5% improvement in rigidity, 69.4% in bradykinesia, and 91.5% in tremor. Adverse events were mild and transient (dysarthria 20-25%, gait instability 25-41%) with no permanent complications.
Conclusions: MRgFUS-STN demonstrates significant efficacy and favorable safety for medication-refractory PD, with outcomes comparable to DBS-STN while offering reduced invasiveness. Larger multicenter trials are warranted for definitive implementation guidelines.