Thalamotomy Eases Tremor, Spares Cognition in Parkinson's

TOPLINEIn patients with tremor-dominant Parkinson's disease, magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy significantly reduced the severity of tremors and the levodopa equivalent daily dose and maintained stable cognitive function, with benefits evident within 24 hours and sustained through 6 months.METHODOLOGYResearchers conducted a prospective observational cohort study at the neurology and stroke unit in Italy to evaluate clinical outcomes over 6 months in patients with tremor-dominant Parkinson's disease following MRgFUS thalamotomy.A total of 107 patients (mean age, 69.365 years; 76.6% men) with Parkinson's disease who underwent MRgFUS for tremor were included between 2018 and 2024. The mean disease duration was 9.23 years.The primary outcome was a change in the severity of tremors assessed using the Fahn-Tolosa-Marin (FTM) Clinical Rating Scale for Tremor and the Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS-III) at baseline, 24 hours, and 1 and 6 months.Secondary outcomes were changes in cognitive scores evaluated using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).The levodopa equivalent daily dose was compared between baseline and 6 months in patients with available medication data.TAKEAWAYThe severity of tremors reduced significantly post-thalamotomy (P < .001), marked by a sharp drop in FTM Clinical Rating Scale for Tremor and MDS-UPDRS-III scores at 24 hours that partially rebounded at 1 month and stabilised through 6 months. Patients with a longer disease duration showed the greatest reduction in FTM Clinical Rating Scale for Tremor scores across all timepoints.A clinically meaningful FTM Clinical Rating Scale for Tremor response was seen in 86.7% of patients at 24 hours, 61.7% at 1 month, and 56.5% at 6 months. Corresponding MDS-UPDRS-III response rates were 60.4%, 38.9%, and 28.6%, respectively.The mean levodopa equivalent daily dose decreased significantly from 479.892 mg/d at baseline to 351.753 mg/d at 6 months (P < .001). Cognitive function remained stable throughout follow-up, with no significant changes in MMSE or MoCA scores.The most common adverse events were dizziness and paraesthesia (5% each), scalp burning and contralateral weakness (4% each), and headache and gait instability (3% each). All adverse events resolved within 6 months, and no serious adverse events, permanent neurologic deficits, or procedure-related hospitalisations were reported.IN PRACTICE"Our findings showed a pronounced initial improvement in tremor after MRgFUS, followed by a mild deterioration at 1 month that subsequently stabilized at 6 months. This pattern suggests that most of the benefit occurs immediately after the intervention, with partial attenuation of the effect across six months," the authors wrote.SOURCEThis study was led by Francesca Pistoia and Federico Salfi, University of L'Aquila, L'Aquila, Italy. It was published online on July 26, 2026, in the Journal of Neurology.LIMITATIONSThe absence of a control group limited the ability to differentiate between the treatment effect and potential placebo responses. The follow-up period was relatively short, which failed to capture late tremor recurrence or the long-term persistence of clinical benefits. The single-centre design and the relatively small sample size of women participants may have limited the generalisability of the findings.DISCLOSURESThis study was funded by the Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila. The authors declared having no conflicts of interest.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.