Category: Education, History, Disparities (Other)
Objective: To explore whether recent developments in Essential Tremor (ET) and new advanced therapies have influenced clinical practice.
Background: Recent advancements in the understanding of ET(1), including tremor classification(2), disease burden(3–10) and the introduction of MRgFUS(11)have reshaped ET care. To explore if those led to any changes in practice, we examined Movement Disorders neurologists’ (MDN) views on ET caseloads, patient severity, and awareness of advanced treatments.
Method: An anonymized web survey was conducted between 16-01-23 and 24-02-23, following relevant data privacy legislation and guidelines. MDN across Europe were asked about ET patients’ caseload, severity and advanced therapies’ use.
Results: 68 MDN completed the survey. While 94.1% were familiar with DBS, only 69.1% were familiar with MRgFUS (Figure 1).
MDN reported that 13.5% of their patients suffered from ET. 69.1% of those presented a moderate to severe condition. Most were managed directly by them, without referral to another neurologist or centre (13%); when the patient was referred to another centre, disease was in most cases severe (52.4%) (Figure 2).
When prescribed, earlier referral of MRgFUS vs DBS was observed: DBS (Mild 4.6%; Moderate 18.3%; Severe 77.2%) MRgFUS (Mild 9.8%; Moderate 35.5%; Severe 54.6%) (Figure 3).
Conclusion: MRgFUS has now been performed in more than 22.000 patient, surpassing DBS in the USA. In ET, it is also one of the endorsed advanced therapies(12–16), however, it remains the least familiar advanced option for neurologists in Europe. The ET caseload is high among MDN, with most patients presenting moderate-to-severe symptoms. Despite this presentation, access to advanced therapy remains low with a heterogenous patient profile. Further study is necessary to explain the low referral rate for all advanced therapies and the differences between referral profiles. Further work should focus on enhancing patients’ access to the appropriate therapies.
Level of knowledge
Caseload, patient severity and referral profile.
Patient profiles
References: 1. Welton, T. et al. Essential tremor. Nat Rev Dis Primers 7, 83 (2021).
2. Bhatia, K. P. et al. Consensus Statement on the classification of tremors. from the task force on tremor of the International Parkinson and Movement Disorder Society. Movement Disord 33, 75–87 (2018).
3. Berry, D. S. et al. Baseline Depressive Symptoms as a Predictor of Incident Dementia in a Prospectively Followed Cohort of Elders with Essential Tremor. Neurodegener. Dis. 24, 80–90 (2024).
4. Chandran, V. & Pal, P. K. Quality of life and its determinants in essential tremor. Parkinsonism Relat D 19, 62–65 (2013).
5. Venkatraman, V. et al. Disparities in the treatment of movement disorders using deep brain stimulation. J. Neurosurg. 1–11 (2024) doi:10.3171/2023.11.jns23882.
6. Gupta, H. V., Pahwa, R., Dowell, P., Khosla, S. & Lyons, K. E. Exploring essential tremor: Results from a large online survey. Clin. Park. Relat. Disord. 5, 100101 (2021).
7. Louis, E. D. & McCreary, M. How Common is Essential Tremor? Update on the Worldwide Prevalence of Essential Tremor. Tremor Other Hyperkinetic Movements 11, 28 (2021).
8. Song, P. et al. The global prevalence of essential tremor, with emphasis on age and sex: A meta-analysis. J Glob Health 11, 04028 (2021).
9. Vetterick, C., Lyons, K. E., Matthews, L. G., Pendal, R. & Ravina, B. The Hidden Burden of Disease and Treatment Experiences of Patients with Essential Tremor: A Retrospective Claims Data Analysis. Adv Ther 39, 5546–5567 (2022).
10. Antonazzo, I. C. et al. Time trends in the incidence of essential tremor: Evidences from UK and France primary care data. Front Neurol 13, 987618 (2022).
11. Elias, W. J. et al. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. New Engl J Medicine 375, 730–739 (2016).
12. Pouratian, N., Baltuch, G., Elias, W. J. & Gross, R. American Society for Stereotactic and Functional Neurosurgery Position Statement on Magnetic Resonance-Guided Focused Ultrasound for the Management of Essential Tremor. Neurosurgery 87, E126–E129 (2019).
13. Pan, L. et al. Consensus for clinical applications of transcranial magnetic resonance-guided focused ultrasound. Chin. Méd. J. (2024) doi:10.1097/cm9.0000000000003308.
14. Stieglitz, L. H. et al. Consensus Statement on High-Intensity Focused Ultrasound for Functional Neurosurgery in Switzerland. Front Neurol 12, 722762 (2021).
15. Deuschl, Prof. Dr. G. & Schwingenschuh, Assoz. Prof. Dr. P. Leitlinien für Diagnostik und Therapie in der Neurologie. Online: www.dgn.org/leitlinien. (2022).
16. Ferreira, J. J. et al. MDS evidence‐based review of treatments for essential tremor. Movement Disord 34, 950–958 (2019).
To cite this abstract in AMA style:
A. Sanchez Fraga, L. Knight, R. Martuscello, C. Tengelin, P. Crivelli, K. Gant, C. Ferrer, A. Grinspan. A Snapshot on Advanced Therapies in Essential Tremor: Insights from a Neurology Survey [abstract]. Mov Disord. 2025; 40 (suppl 1). https://www.mdsabstracts.org/abstract/a-snapshot-on-advanced-therapies-in-essential-tremor-insights-from-a-neurology-survey/. Accessed October 5, 2025.« Back to 2025 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/a-snapshot-on-advanced-therapies-in-essential-tremor-insights-from-a-neurology-survey/