Objective: To assess the efficacy and safety of bilateral magnetic resonance imaging-guided focused ultrasound thalamothomy for medication refractory essential tremor in prospective observation of two clinical cases.

Background: Essential tremor (ET) usually affects both sides of the body and it is reasonable to perform surgery bilaterally to achieve the most positive treatment effect in cases of severe refractory ET. The limitation on carrying out this procedure bilaterally at once may be the risk of adverse effects. One of the most disabling complications might be the speech disturbance.

Method: Bilateral thalamothomy in the projection of ventral intermedius nucleus of the thalamus was performed under the guidance of magnetic resonance imaging in two male patients with ET more than one year later after the first intervention between June 2020 and January 2022 . The Clinical rating scale of ET (CREST) was used to assess the severity and disabling effect of tremor. Cognitive status was evaluated with Montreal Cognitive Assessment Scale (MoCA). Before the first operation ET was unsuccessfully treated by all the first line medications. Both patients were right-handed and prefer to be operated on the left thalamus at first, and just then – on the right thalamus.

Results: Patients mean age was 32.25 years. Duration of the disease before the first procedure was 24 years in patient 1 and 25 years in patient 2 respectively.  The interval before procedures was 17 months for both patients. The results of follow-up are shown in the table 1.
There were no such adverse effects as cognitive decline, gait impairment, dysarthria, vertigo, dysphagia. After the first operation Patient 2 had permanent adverse effect of slight tingling and numbness in the right half of lower lip and in first and second fingers of the right hand.

Conclusion: Bilateral Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy can be considered an effective and safe procedure in the treatment of medication-resistant essential tremor. Side effects in a series of our observations were not severe, did not lead to disability and did not cause a negative reaction from the patient.

« Back to 2022 International Congress

MDS Abstracts - https://www.mdsabstracts.org/abstract/bilateral-magnetic-resonance-imaging-guided-focused-ultrasound-thalamotomy-in-medication-resistant-essential-tremor-treatment/