Objective: To evaluate whether socioeconomic factors are associated with receipt of unilateral versus bilateral high-intensity MRI-guided focused ultrasound (HIFU) among patients with essential tremor.

Background: HIFU is an established treatment for medication-refractory essential tremor, with unilateral treatment performed first, followed by completion of bilateral treatment within 6-9 months. While second treatment may provide additional functional benefit for patients with bilateral symptoms, it requires repeat procedures and continued healthcare engagement, potentially introducing socioeconomic barriers. Understanding whether such factors influence access to bilateral HIFU is critical to identifying disparities in advanced tremor care.

Method: In this IRB-approved retrospective study, patients with essential tremor who underwent HIFU between 2019 and 2025 were identified using CPT codes. Demographic and clinical variables, including age, sex, ZIP code, symptom onset, procedure laterality, and operative date, were extracted from the medical record. Social Deprivation Index (SDI) was derived from ZIP code, and disease duration at intervention was calculated. Comparisons between unilateral and bilateral groups were performed using R.

Results: Among 200 patients, 173 underwent unilateral and 27 underwent bilateral HIFU. Patients receiving unilateral treatment were older at initial procedure than those completing bilateral therapy (median 77 vs 75 years; p=0.042). Disease duration (median 20 years; p=0.898), sex distribution (p=0.929), and SDI (38.0 vs 34.5; p=0.53) did not differ significantly between groups.

Conclusion: In patient and physician decision-making for HIFU candidacy, socioeconomic deprivation was not associated with completion of bilateral therapy, whereas younger age at initial treatment was. These findings suggest that age may be a key determinant in pursuit of bilateral HIFU and challenge assumptions that socioeconomic status is the primary barrier to advanced tremor interventions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/equity-in-access-to-bilateral-high-intensity-mri-guided-focused-ultrasound-for-essential-tremor/