Ultrasuoni focalizzati guidati da risonanza magnetica (MRgFUS) per il tremore: risultati cognitivi a breve e a lungo termine

Parkinson's disease (PD) and essential tremor (ET) are two of the most disable conditions among of movement disorders. Traditionally, drug therapy has been the primary method for managing these conditions. However, not all patients respond adequately to initial drug treatments. In recent years, high-intensity focused ultrasound (HIFU) has emerged as a medical procedure for treating various conditions, including tumors, uterine fibroids, and tremors. Magnetic resonance-guided ventral intermediate nucleus (Vim) thalamotomy (MRgFUS-VIM) is as a minimally invasive procedure to the treatment of tipically refractory tremor. By utilizing targeted ultrasound, a lesion is induced in the ventral intermediate nucleus, leading to a reduction in tremors on the contralateral side of the body relative to the targeted nucleus. Nonetheless, despite its minimally invasive nature, the procedure carries risks, such as potential postoperative cerebral edema, leading to complications like speech impairments, gait instability, and weakness in the limbs. Despite the established clinical efficacy, there are current inconsistencies and gaps in the literature concerning potential cognitive deficits post-treatment. Some reports indicate a decline in verbal fluency and verbal memory when targeting the left VIM, while sporadic visuospatial deficits have been noted when targeting the right VIM. The primary aim of this study was to prospectively assess any short- and long-term cognitive sequeale following the treatment. Following approval by the ethics committee of the University of L'Aquila (08/22), all eligible patients were enrolled in the study and evaluated using a comprehensive battery of neuropsychological, clinical, and behavioral assessments at three distinct intervals: pre-treatment, six months and one year post-treatment. After adjusting for age and education level and confirming data normality via the Shapiro-Wilk test, statistical analyses were performed, employing a paired T-tests or a Wilcoxon signed-rank tests. Significance was determined at a level of 0.003, adjusted using Bonferroni correction for multiple tests (0.05/14). The findings affirm the long-term effectiveness and safety of unilateral MRgFUS treatment, demonstrating sustained cognitive stability over time.