Original Article: Parkinson Disease

Issue Date: December 1, 2020

Available at: https://www.aafp.org/afp/2020/1201/p679.html

To the Editor: I am a family physician who has Parkinson disease and read with great interest the superb review article by Drs. Halli-Tierney and colleagues. I want to offer a surgical option that was not discussed in the article.

I was the recipient of a near-miraculous treatment for tremors called focused ultrasound subthalamotomy.¹ This outpatient procedure is best suited for people who have Parkinson disease with unilateral tremor. The procedure creates a lesion in the ventrolateral thalamus using ultrasonography and magnetic resonance imaging guidance. Unlike deep brain stimulation, this procedure involves no cutting, and there is no need for battery-driven stimulation.

Before this procedure, I had a debilitating left arm and hand tremor that was barely responsive to pharmacologic treatment. The tremor made things like holding a phone impossible, caused constant painful lateral epicondylitis, and resulted in nightly insomnia from regularly flicking myself. My neurosurgeon classified my tremor as a “4+” out of 4. During the ultrasound subthalamotomy, an 8-mm lesion was created (while I was fully awake) that resulted in immediate and complete resolution of the tremor. Although adverse effects reported in a recent randomized controlled trial included weakness on the treated side, speech and gait disturbances, and dyskinesia for up to 12 months,¹ I have been fortunate not to experience any of these. An unexpected bonus has been a significantly decreased need for carbidopa/levodopa (Sinemet) with a resultant noticeable decrease in medication-mediated dyskinesias.

Although focused ultrasound subthalamotomy is not a treatment applicable to all people with Parkinson disease, family physicians should be aware of its existence in the neurosurgeon's toolbox.

Editor's Note: This letter was sent to the authors of “Parkinson Disease,” who declined to reply.