Objective: To report our single-center experience with unilateral MRI guided high intensity focused ultrasound (MRgFUS) ventral intermediate nucleus (VIM) thalamotomy for patients with disabling essential tremor (ET).

Background: ET causes functional disability, social isolationand psychological distress. Some patients are refractory or intolerant to medical treatment. MRgFUS can be applied to the thalamus without any craniotomy or insertion of brain electrodes to produce a surgical lesion. Due to its novelty less is known on the clinical outcomes than the more established thalamic deep brain stimulation, radiofrequency and gamma knife thalamotomy.

Method: We prospectively followed 25 patients diagnosed with disabling ET who underwent unilateral MRgFUSthalamotomy at Sheba Medical Center. All patients were assessed prior and 3, 6 and 12 months after the procedure, using the Clinical Rating Scale for Tremor (CRST), the Essential Tremor Rating Assessment Scale (TETRAS) and other tests for cognitive function, quality of life, anxiety and reporting of side effects.

Results: 18/25 patients improved in terms of tremor by more than 50% after 3-6 months and this improvement remained significant at 12 months post-op. Contralateral upper limb tremor CRST score decreased by 60% in average (from 6 to 2 )while CRST score of the ipsilateral UL remained unchanged. In terms of safety, the most common side effect was ataxia (n=12) and lasted less than 4 weeks in 7/12 patients. None of the patients showed any signs of cognitive deterioration 6 months after the procedure.

Conclusion: We report clinical efficacy and safety that are similarly favorable as other surgical modalities for tremor and that are similar to results published in the literature.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mri-guided-high-intensity-focused-ultrasound-thalamotomy-for-essential-tremor-efficacy-and-safety-at-1-year-follow-up/