Efficacy and safety of MRI-guided focused ultrasound lesioning for tremor-dominant Parkinson Disease: A systematic review and meta-analysis.

Background and Objctives Tremor-dominant Parkinson’s disease (TD-PD) remains challenging to manage when symptoms persist despite optimized mediecal therapy. MRI-guided focused ultrasound (MRgFUS) lesioning has emerged as a non-invasive treatment option for medically refractory tremor. To evaluate the efficacy and safety of MRgFUS lesioning specifically in adults with TD-PD. Methods The systematic review and meta-analysis included 16 studies of adult patients with TD-PD who received MRgFUS lesioning targeting the ventral intermediate nucleus (Vim) of the thalamus or the subthalamic nucleus (STN), conducted using RevMan 5.4. Extracted data included tremor scores, UPDRS motor scores, and reported adverse events. Comprehensive searches of PubMed, Scopus, Web of Science, Embase, and Google Scholar were performed to identify peer-reviewed articles published from 2010 to 2025. Results MRgFUS lesioning significantly improved tremor and UPDRS scores. Tremor scores improved in the short-term (< 6 months; pooled SMD = 2.03 [1.35–2.71], I² = 0%) and long-term (> 6 months; pooled SMD = 1.23 [0.82–1.64], I² = 0%), with an overall pooled SMD of 1.50 [1.03–1.98], I² = 41%. UPDRS scores also improved significantly (< 6 months SMD = 1.56 [0.95–2.16], I² = 0%; > 6 months SMD = 0.75 [0.41–1.09], I² = 11%; overall SMD = 0.97 [0.60–1.34], I² = 36%). Sensitivity analyses confirmed the robustness fo these findings. Adverse events were mostly mild-to-moderate, including gait, sensory, speech, limb, facial, and tongue-related disturbances; ≤19% persisted long-term. Conclusion MRgFUS lesioning is a safe and effective treatment for TD-PD, providing substantial short-term and long-term tremor improvements and significant UPDRS score improvements, with mostly mild, transient adverse effects.