Title: Motor and Quality‑of‑Life Outcomes After MR‑Guided Focused Ultrasound Subthalamotomy for Parkinson’s Disease: A Meta‑analysis
Authors: Ashwin Achuthaprasad, Jamir Pitton Rissardo, Jorge Patino, Ana Leticia Fornari Caprara, Andrew McGarry, Ian Walker
Conference: 2026 International Congress of Parkinson's Disease, Seoul, Korea
Objective
To evaluate the efficacy and safety of MR‑guided focused ultrasound (MRgFUS) subthalamotomy for improving motor symptoms, medication burden, and quality of life in Parkinson’s disease (PD).
Background
MRgFUS subthalamotomy has emerged as a minimally invasive alternative for unilateral or bilateral lesioning in patients with PD. Multiple cohorts have reported improvement in motor symptoms, though variability across studies and follow‑up intervals remains. A pooled synthesis of outcomes can clarify the magnitude and durability of treatment effects.
Design/Methods
A systematic review of PubMed‑indexed clinical studies reporting pre‑ and post‑treatment outcomes of MRgFUS subthalamotomy was performed. Extracted measures included MDS‑UPDRS III (OFF), MDS-UPDRS II, PDQ‑39, and levodopa equivalent daily dose (LEDD). Adverse events (AEs) and their proportions were also collected. Random‑effects and fixed‑effect meta‑analyses were conducted across time points from 1 to 12 months.
Results
Across 5 studies (80 patients), MRgFUS subthalamotomy produced a significant improvement in MDS-UPDRS-III at all time points (MD −14.12; 95% CI −18.88 to −9.36; I2 97%) [Figure 1]. MDS-UPDRS II improved (MD −3.79; 95% CI −5.03 to −2.56; I2 0%), as did PDQ‑39 (MD −6.70; 95% CI −9.48 to −3.92; I2 0%) [Figure 2]. LEDD decreased by −148.89 mg (95% CI −210.32 to −87.45; I2 0%) [Figure 3]. Meta‑regression demonstrated that time from baseline did not significantly moderate outcomes. The most common AEs were gait ataxia (p=0.4; 95% CI 0.30–0.51), dyskinesia (p=0.35; 95% CI 0.25–0.45), dysarthria (p=0.31; 95% CI 0.22–0.42), and facial asymmetry (p=0.2; 95% CI 0.12–0.30).
Conclusions
MRgFUS subthalamotomy provides consistent, clinically meaningful reductions in motor severity, disability, and medication use up to 12 months post‑procedure. While generally well tolerated, transient gait and speech disturbances remain common. Further randomized and long‑term comparative studies are needed to refine patient selection and optimize safety.
Citation
Achuthaprasad A, Rissardo JP, Patino J, Caprara AL, McGarry A, Walker I. Motor and Quality‑of‑Life Outcomes After MR‑Guided Focused Ultrasound Subthalamotomy for Parkinson’s Disease: A Meta‑analysis. Mov Disord 2026;41(Suppl_1):S1269-S1272.
Figure 1. Forest plot of pooled MD of motor outcomes.
Figure 2. Forest plot of pooled MD of PDQ-39 outcomes.
Figure 3. Forest plot of pooled MD of LEDD.