Magnetic resonance-guided focused ultrasound subthalamotomy for Parkinson's disease: a meta-analysis of effectiveness and safety

This systematic review and meta-analysis aimed to evaluate the safety and effectiveness of magnetic resonance-guided focused ultrasound (FUS) subthalamotomy in patients with Parkinson's disease (PD), focusing on improvements in motor symptoms, quality of life (QoL), medication burden, and adverse events (AEs). Following PRISMA and Cochrane guidelines, a comprehensive search was conducted across PubMed, Cochrane CENTRAL, Scopus, and Web of Science up to November 2025. Studies were included if they assessed the safety or efficacy of unilateral or bilateral FUS-STN in PD. Data extraction and risk of bias assessment were independently conducted by two reviewers. Meta-analyses at six months used a random effects model to pool mean differences (MD) with 95% confidence intervals (CI). Five studies (n = 75) were included. FUS-subthalamic nucleus (STN) significantly reduced Movement Disorder Society-Sponsored Unified PD Rating Scale, Part III (MDS-UPDRS-III) scores at six months (MD:-11.05; 95% CI: [-14.68,-7.42]; P < 0.00001), with greater effects off-medication (P = 0.0009). Treated-side scores improved (MD:-10.67; 95% CI: [-13.41,-7.92]), while untreated-side scores did not. Significant improvements were also seen in MDS-UPDRS-II (MD:-3.58; 95% CI: [-4.84,-2.32]; P < 0.00001), PD Questionnaire-39 (PDQ-39) (MD:-8.55; 95% CI: [-13.51,-3.58]; P = 0.0007), and levodopa equivalent daily dose (LEDD) (MD:-111.63 mg; 95% CI: [-162.52,-60.74]; P < 0.0001). Common AEs included dyskinesia (9.2%), gait disturbance (6.9%), and dysarthria (6.4%). FUS-STN significantly improves motor function, daily living activities, and QoL (PDQ-39) and reduces dopaminergic medication burden in PD patients with asymmetrical symptoms. AEs were generally mild and manageable, supporting its role as a safe, effective, and non-incisional alternative to conventional surgical options.