Is Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound a Repeatable Treatment Option? Case Report of a Retreated Patient With Tremor Combined With Parkinsonism

Abstract

INTRODUCTION:In recent years, transcranial Magnetic Resonance Imaging-guidedFocused Ultrasound (tcMRgFUS) treatments for functional neurological disorders aregiving a new thrust to the field of therapeutic brain lesioning.OBJECTIVE:To present the case of a patient affected by tremor combined with Parkin-sonism who underwent a second tcMRgFUS thalamotomy because of relapsing tremorafter a few months from the first tcMRgFUS treatment.METHODS:A 72-yr-old, right-handed man, came to our observation because of a disablingtremor affecting his upper limbs, refusing any invasive surgical procedure and alreadytreated by tcMRgFUS left Vim thalamotomy. However, clinical benefit had brief duration,as a progressive recurrence of tremor on the right upper limb was observed after a fewmonths from the first treatment. Thus, the patient underwent a new left-sided tcMRgFUSprocedure 6 mo after the former treatment.RESULTS:After the second procedure, an immediate and complete relief from tremoron the right upper limb was achieved with clinical benefit that persisted up to a 6-mofollow-up.CONCLUSION:Since tcMRgFUS doesn’t use ionizing radiations and it is incision-less,repeated and staged treatment procedures have always been hypothesized. Our reportsuggests that tcMRgFUS retreatment might actually be a feasible, safe, and effective optionin selected patients in whom an optimal clinical outcome is not achieved after the firsttreatment session. However, future well-designed studies in large samples are needed toassess the possible risks of retreatment and the optimal timing of reintervention as well aseligibility and exclusion criteria.