Effectiveness and Safety of Magnetic Resonance-guided Focused Ultrasound Subthalamotomy and Pallidotomy for Parkinson’s Disease: A Systematic Review and Meta-analysis
Abdallah Abbas1, Basant Lashin2, Haneen Sabet3, Moaz Elsayed Abouelmagd4, Mahmoud Tarek Hefnawy5, Salma Bakr6, Mohamed Ahmed Zanaty3, Mohamed El-Moslemani1, Mohamed Mohesn Helal4, Ahmed Negida7, Ahmed M. Raslan8
1Faculty of Medicine, Al-Azhar University, Damietta, Egypt., 2Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA., 3Faculty of Medicine, South Valley University, Qena, Egypt., 4Faculty of Medicine, Cairo University, Cairo, Egypt., 5Faculty of Medicine, Zagazig University, Zagazig, Egypt., 6Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt., 7Virginia Commonwealth University, 8Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
Objective:
Magnetic resonance–guided focused ultrasound (MRgFUS) has emerged as a noninvasive alternative to deep brain stimulation (DBS) for Parkinson’s disease (PD). Although the subthalamic nucleus (STN) and globus pallidus internus (GPi) are well-established surgical targets, their relative effectiveness and safety when treated with MRgFUS have not been clearly defined.
Background:
MRgFUS is a noninvasive alternative to DBS for Parkinson’s disease, but the optimal neural target and comparative outcomes remain uncertain.
Design/Methods:
A systematic review and meta-analysis was conducted in accordance with PRISMA and Cochrane guidelines. CENTRAL, PubMed, Web of Science, and Scopus were searched through May 2025 for studies assessing MRgFUS targeting the STN or GPi in patients with PD. Key outcomes included motor and functional performance using the Unified Parkinson’s Disease Rating Scale (UPDRS), levodopa-equivalent daily dose (LEDD), and adverse events (AEs). Random-effects models were used to calculate pooled mean differences (MD) with 95% confidence intervals (CI).
Results:
Nine studies with 135 patients, including two randomized controlled trials, were included. Both STN and GPi lesioning produced significant motor improvement at 6 months. Off-medication UPDRS-III improved by –13.39 after STN and –8.09 after GPi. On-medication scores improved with STN (–7.89), while GPi showed no significant change. Functional scores (UPDRS-II) improved with both targets, whereas motor complication scores (UPDRS-IV) improved more with GPi (–5.04 vs –1.31). STN lesioning led to a significant reduction in LEDD (–100.25 mg), whereas GPi did not. Adverse event patterns differed: GPi was more commonly associated with dyskinesia, gait disturbance, and dysarthria, while STN was linked to dizziness and headaches.
Conclusions:
Both STN- and GPi-targeted MRgFUS demonstrate meaningful short-term clinical benefits in Parkinson’s disease. STN lesioning appears superior in reducing dopaminergic medication requirements, whereas GPi lesioning more effectively mitigates motor complications. These findings underscore the need for head-to-head randomized trials to establish the optimal target, clarify long-term efficacy and safety.
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