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Am Fam Physician. 2021;103(10):581

Original Article: Parkinson Disease

Issue Date: December 1, 2020

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.

Email letter submissions to afplet@aafp.org. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

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