Objective: To assess the efficacy and safety of Magnetic Resonance Guided Focused Ultrasound (MRgFUS) for Essential Tremor (ET) and Tremor Dominant Parkinson’s Disease (TDPD) in South Indian population.

Background: Unilateral MR-guided focused ultrasound (MRgFUS) ventral intermediate nucleus (VIM) thalamotomy for treatment of medically refractory and debilitating tremor is an FDA approved treatment for essential tremor (ET) since July 2016 and tremor dominant Parkinson’s disease (TDPD) since December 2018. Here we report our experience in treating 6 patients with MRgFUS since December 2024.

Method: • Patients with disabling medication-refractory ET and TDPD, who regarded their arm tremor as disabling in daily life activiites were treated with MRgFUS. All patients were offered either deep brain stimulation or MRgFUS and preferred MRgFUS as their treatment of choice. Patients were eligible for FUS only after a Movement Disorders Neurologist verified that they were given optimal medication trial for tremor relief. All patients had no contraindications for the procedure, such as significant cognitive decline, current anticoagulant or antiplatelet therapy, brain tumors, vascular malformations, significant unstable medical conditions, and contraindications for MR, including claustrophobia.

Results: A total of 6 patients were treated in last 4 months since December 2024, out of which 3 patients had ET and 3 patients had TDPD. Treatment resulted in immediate complete cessation of the rest tremor and action tremor at the end of the procedure, in the treated arm in all three ET patients and arm and leg tremor, rigidity and bradykinesia all TDPD patients. Hemi CRST and Hemi UPDRS scores were 0 on treated side after treatment which persisted after 1 month of follow up in all patients. Adverse effects included nausea, hand paresthesias in one patient, ipsilateral limb and gait ataxia in 3 patients and drowsiness and involuntary movements in one patient. These were mild and resolved completely in 4 patients in one week and in one month in 1 patient.

Conclusion: MRgFUS is an effective and safe procedure for patients with ET and TDPD who are not eligible or willing for DBS. It is a good noninvasive treatment option with minimal side effects for patients who do not want to undergo surgery.Adverse effects were mild and resolved significantly within one week in most of the patients.

References: 1. Zaaroor M, Sinai A, Goldsher D, Eran A, Nassar M, Schlesinger I: Magnetic resonance-guided focused ultrasound thalamotomy for tremor: a report of 30 Parkinson’s disease and essential tremor cases. J Neurosurg 128:202-210, 2018.
2. Stacy MA, Elble RJ, Ondo WG, Wu SC, Hulihan J: Assessment of interrater and intrarater reliability of the FahnTolosa-Marin Tremor Rating Scale in essential tremor. Mov Disord 22:833-838, 2007
3. Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing resultst Christopher G. Goetz, Barbara C. Tilley, Stephanie R. Shaftman, Glenn T. Stebbins, Stanley Fahn, Pablo Martinez-Martin. Movement Disorders, 23(15):2129-170.
4. Sinai A, Nassar M, Eran A, Constantinescu M, Zaaroor M, Sprecher E, Schlesinger I (2019) Magnetic resonanceguided focused ultrasound thalamotomy for essential tremor: A 5-year single-center experience. J Neurosurg 5

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