Objective: To report the clinical experience in our center (CINAC-HM Puerta del Sur) in the treatment of essential tremor (ET) with Magnetic Resonance guided Focused Ultrasound (MRgFUS).

Background: Patients suffering from medically-refractory and disabling ET can benefit from surgical treatments such as radiofrequency thalamotomy and thalamic DBS (1). The appearance of MRgFUS, an incisionless technique for lesioning deep brain structures without the need of surgery, has paved the way for the rebirth of ablative approaches for Movement Disorders. A recent double-blind sham-controlled randomized clinical trial has confirmed the safety and effectiveness of MRgFUS unilateral thalamotomy for the treatment of ET (2).

Methods: Patients with disabling ET that had not responded to at least two trials of medical therapy underwent unilateral VIM-thalamotomy with MRgFUS. Tremor severity was assessed through the Clinical Rating Scale for Tremor (CRST) at baseline, 1, 3, 6 and 12 months after treatment. The scale is divided into 3 parts: A) quantification of tremor at rest, with posture, and with intention in nine body parts; B) task performance; C) functional disability. A visual analogue scale for the assessment of overall quality of life (VAS-QUEST) (ranging from 0 to 100%, with higher scores indicating better perceived quality of life) was also given pretreatment and one year after procedure. Treatment-related adverse events were also registered. Paired T-test was used for comparison from baseline to last follow-up.

Results: Tweny-one ET patients were included [table 1]. Total CRST score showed improvement from 54.9 ± 16.5 at baseline to 28.2 ± 18.4 at 12 months (mean reduction of 51.7 %). CRST-A score for the treated hemibody was reduced from 6.8 ± 2.4 to 1.7 ± 1.8 (75.6%). CRST-C score improved from 17.9 ± 4.6 to 5.6 ± 6.1 (72.1 %) [table 2]. The VAS-QUEST improved from 42.6 ± 21.1 before treatment to 68.3 ± 21.2 at last follow-up. The most frequent adverse event immediately after treatment was gait unstability (16 patients, 76%); which was moderate (lateralization and wide-based gait) in 5 cases. In one patient, mild ataxia (abnormal tandem gait) persisted at 1 year [table 3].

Conclusions: Our results support previous evidence showing that MRIgFUS is safe and effective for the treatment of ET and allows improvement in daily living disability.

References: 1. Deuschl G, Raethjen J, Hellriegel H, Elble R. Treatment of patients with essential tremor. Lancet Neurol 2011;10(2):148-61. 2. Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016 Aug 25;375(8):730-9.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/magnetic-resonance-guided-focused-ultrasound-unilateral-thalamotomy-for-the-treatment-of-essential-tremor-outcomes-and-complications-after-1-year-of-follow-up-in-21-patients/