MRI-Guided Focused Ultrasound for the Treatment of Dystonia: A Narrative Review

Sheikh Muktadir Bin Momin; Kristian Aquilina; Harry Bulstrode; Takaomi Taira; Suneil Kalia; Ammar Natalwala

doi:10.7759/cureus.54284

MRI-Guided Focused Ultrasound for the Treatment of Dystonia: A Narrative Review

Cureus. 2024 Feb 16;16(2):e54284. doi: 10.7759/cureus.54284. eCollection 2024 Feb.

Authors

Sheikh Muktadir Bin Momin^{1

2}, Kristian Aquilina³, Harry Bulstrode⁴, Takaomi Taira⁵, Suneil Kalia⁶, Ammar Natalwala^{7

8}

Affiliations

¹ Institute of Inflammation & Ageing, University of Birmingham, Birmingham, GBR.
² Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, GBR.
³ Department of Paediatric Neurosurgery, Great Ormond Street Hospital, London, GBR.
⁴ Department of Neurosurgery, Wellcome-MRC Cambridge Stem Cell Institute, Addenbrooke's Hospital, Cambridge, GBR.
⁵ Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, JPN.
⁶ Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, CAN.
⁷ Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, GBR.
⁸ Department of Neuromuscular Diseases, Institute of Neurology, University College London, London, GBR.

Abstract

Contemporary surgical management of dystonia includes neuromodulation via deep brain stimulation (DBS) or ablative techniques such as radiofrequency (RF) ablation. MRI-guided focused ultrasound (MRgFUS) is an emerging modality that uses high-intensity ultrasound to precisely ablate targets in the brain; this is incisionless, potentially avoiding the surgical risks of a burr hole and transcortical tract to reach the anatomical target. There is some evidence of efficacy in essential tremor and Parkinson's disease (PD), but, to date, there is no study aggregating the evidence of MRgFUS in dystonia. In this narrative review, we searched Medline, Embase, CINAHL, EBSCO, and ClinicalTrials.gov for primary studies and clinical trials on MRgFUS in the treatment of dystonia. Data were analyzed concerning dystonia phenotype, reported outcomes, and complications. PD-related dystonia was also included within the scope of the review. Using our search criteria, six articles on the use of MRgFUS in adult dystonia and three articles on the use of FUS in dystonia in PD were included. Four trials on the use of FUS in dystonia were also found on ClinicalTrials.gov, one of which was completed in December 2013. All included studies showed evidence of symptomatic improvement, mostly in focal hand dystonia; improvements were also found in dystonia-associated tremor, cervicobrachial dystonia, and dystonia-associated chronic neuropathic pain as well as PD-related dystonia. Reported complications included transient neurological deficits and persistent arm pain in one study. However, the evidence is limited to level-4 case series at present. MRgFUS is an emerging modality that appears to be safe and effective, particularly in focal hand dystonia, without major adverse effects. However, the quality of evidence is low at present, and long-term outcomes are unknown. High-quality prospective studies comparing MRgFUS to other surgical techniques will be useful in determining its role in the management of dystonia.

Keywords: dystonia; focused ultrasound; functional neurosurgery; movement disorders; parkinson's disease.

Publication types

Review