Role of deep brain stimulation therapy in the magnetic resonance-guided high-frequency focused ultrasound era: current situation and future prospects

ABSTRACT

Introduction: Deep brain stimulation (DBS) is a well-established treatment of movement disorders; but recently there has been an increasing trend toward the ablative procedure magnetic resonance-guided focused ultrasound (MRgFU). DBS is an efficient neuromodulatory technique but associated with surgical complications. MRIgFUS is an incision-free method that allows thermal lesioning, with fewer surgical complications but irreversible effects.

Areas covered: We look at current and prospective aspects of both techniques. In DBS, appropriate patient selection, improvement in surgical expertise, target accuracy (preoperative and intraoperative imaging), neurophysiological recordings, and novel segmented leads need to be considered. However, increased number of older patients with higher comorbidities and risk of DBS complications (mainly intracranial hemorrhage, but also infections, hardware complications) make them not eligible for surgery. With MRgFUS, hemorrhage risks are virtually nonexistent, infection or hardware malfunction are eliminated, while irreversible side effects can appear.

Expert commentary: Comparison of the efficacy and risks associated with these techniques, in combination with a growing aged population in developed countries with higher comorbidities and a preference for less invasive treatments, necessitates a review of the indications for movement disorders and the most appropriate treatment modalities.

KEYWORDS:

• Deep brain stimulation
• MRI-guided focused ultrasound
• essential tremor
• Parkinson’s disease
• surgical complications
• neurophysiological biomarkers
• directional leads
• thermal lesion

Article highlights

• Deep brain stimulation developments in neuroimaging, surgical techniques, neurophysiological biomarkers, and directional leads have improved target accuracy and efficiency while decreasing surgical risks inherent to this treatment.

• Review of the risk of hemorrhage from the literature and an analysis of the current percent of bleeding has been conducted. Results show a significant decrease in major risks.

• Novel treatment of movement disorders using magnetic resonance-guided focused ultrasound allows thermal lesioning, which largely avoids surgical complications.

• Unilateral treatment for essential tremor has proven to be effective, and promising results have been published in Parkinson’s disease. Due to irreversible effects, bilateral procedures are still questioned.

• Comparison between these two techniques, and current and future perspectives, are discussed in this article.

Declaration of interest

C Fernandez Garcia, F Alonso-Frech, M HG Monje and J Matías-Guiu have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Peer Reviewer Disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

We would like to acknowledge Deborah Nock (Medical WriteAway, Norwich, UK) for her writing and editorial assistance to this paper.

Additional information

Funding

This paper was not funded.