Objective: This study aims to present the clinical experience and outcomes of Magnetic Resonance-guided Focused Ultrasound (MRgFUS) thalamotomy cases performed at a single specialized center in Turkey.

Background: MRgFUS thalamotomy represents an innovative and non-invasive therapeutic modality for the management of medically refractory essential tremor (ET).

Method: Postoperative score changes in CRST, TETRAS, and QUEST assessments, administered to all patients before and after MRgFUS, were calculated. Furthermore, lesion size and adverse effects were evaluated.

Results: Unilateral MRgFUS thalamotomy was performed in 17 patients with medically refractory ET. At the time of the procedure, the mean age was 69.7±9.7 years, mean age at tremor onset was 45.1±21 years, and mean disease duration was 24.6±19.2 years. The mean skull density ratio (SDR) was 0.50±0.08, and the mean lesion size was 7.1±1.61 mm.

Mean improvements of 65% in CRST, 91% in TETRAS, and 59% in QUEST were observed. Mild tremor recurrence was noted in one patient at the 3-month follow-up. In models adjusted for preoperative scores, age at onset did not significantly predict postoperative score changes (β=-0.0592, p=0.072; β=-0.259, p=0.120; and β=-0.006, p=0.791, respectively). A negative trend was observed between age at onset and postoperative TETRAS scores (β=0.0592, p=0.072). While tremor duration did not predict postoperative QUEST scores (β=0.0418, p=0.134), it was a significant predictor for CRST and TETRAS, showing a positive correlation (β=0.427, p=0.017 and β=0.0895, p=0.009, respectively).

The most frequent postoperative adverse effects were ataxia (29%), sensory impairment (29%), and dysarthria (2%). All adverse events resolved over time.

Conclusion: Our study is significant as it presents the clinical outcomes of the first patients to undergo MRgFUS in Turkey. While our findings confirm the efficacy of MRgFUS in ET, they indicate that tremor duration may predict postoperative outcomes, whereas age at onset was not predictive. This relationship between tremor duration and postoperative symptom severity is thought to be explained by maladaptive plasticity and reorganization resulting from prolonged disease duration.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-outcomes-and-predictors-of-mr-guided-focused-ultrasound-thalamotomy-in-medically-refractory-essential-tremor-initial-experience-in-turkey/