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Some selected anatomical structures can be targeted by MRgFUS in PD. However, there is no uniform target yet. We have reported that stepwise dual\u2010target MRgFUS was successfully applied to treat refractory tremors with akinetic\u2013rigid features in PD. It generated two precise thermal ablations in the ventral intermediate nucleus (VIM) and pallidothalamic tract (PTT). Here, we report more PD patients to verify the safety and efficacy of stepwise dual\u2010target MRgFUS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ten tremor\u2010dominant PD patients (mean age\u2009=\u200966.7\u2009\u00b1\u20093.2\u2009years, eight men) received the stepwise dual\u2010target MRgFUS treatment with a series of primary and secondary outcome measures. The VIM and PTT were navigated based on brain magnetic resonance images. Outcome measures were categorized into primary and secondary assessments. The primary outcome measures consisted of resting tremor, action\/kinetic tremor, rigidity, and bradykinesia. Secondary outcome measures encompassed non\u2010motor symptoms scale of PD. Data collected at follow\u2010up time points, including 1\u2009day, 3\u2009months, 6\u2009months, and 1 year posttreatment, were compared with baseline data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The severity of tremor and motor deficits represented by Clinical Rating Scale for Tremor parts A and B during off\u2010medication status and Unified Parkinson's Disease Rating Scale III on the treated side were significantly improved (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05 by paired <jats:italic>t<\/jats:italic>\u2010test) at 1\u2010year follow\u2010up. At the 1\u2010year follow\u2010up, significant improvement was observed in the non\u2010motor symptoms scale. Additionally, no severe adverse effects were reported, except temporary treatment\u2010related discomfort during the procedure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In conclusion, stepwise dual\u2010target MRgFUS emerges as a safe and effective therapeutic modality for PD patients, particularly in addressing medication\u2010refractory tremor and akinetic\u2013rigid syndrome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.16468","type":"journal-article","created":{"date-parts":[[2024,9,17]],"date-time":"2024-09-17T14:40:58Z","timestamp":1726584058000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Stepwise dual\u2010target <scp>magnetic resonance<\/scp>\u2010guided focused ultrasound in tremor\u2010dominant Parkinson disease: One\u2010year follow\u2010up"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7146-1482","authenticated-orcid":false,"given":"Jui\u2010Cheng","family":"Chen","sequence":"first","affiliation":[{"name":"Neuroscience and Brain Disease Center China Medical University  Taichung Taiwan"},{"name":"School of Medicine, College of Medicine China Medical University  Taichung Taiwan"},{"name":"Department of Neurology China Medical University Hsinchu Hospital  Hsinchu Taiwan"},{"name":"Neuroscience Laboratory, Department of Neurology China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun\u2010Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Neuroscience and Brain Disease Center China Medical University  Taichung Taiwan"},{"name":"Department of Medical Imaging China Medical University Hospital  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Aoh","sequence":"additional","affiliation":[{"name":"Division of Parkinson's Disease and Movement Disorders, Department of Neurology China Medical University Hospital  Taichung Taiwan"},{"name":"Graduate Institute of Biomedical Sciences, College of Medicine China Medical University  Taichung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2768-4399","authenticated-orcid":false,"given":"Ming\u2010Kuei","family":"Lu","sequence":"additional","affiliation":[{"name":"Neuroscience and Brain Disease Center China Medical University  Taichung Taiwan"},{"name":"Neuroscience Laboratory, Department of Neurology China Medical University Hospital  Taichung Taiwan"},{"name":"Division of Parkinson's Disease and Movement Disorders, Department of Neurology China Medical University Hospital  Taichung Taiwan"},{"name":"Graduate Institute of Biomedical Sciences, 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