Objective: To probe the characteristics of individuals undergoing MRI-guided focused ultrasound (MRgFUS).

Background: MRgFUS has emerged as a non-invasive treatment that alleviates tremor through targeted lesioning, offering significant tremor reduction with a favorable safety profile for medication-refractory patients. Despite its efficacy, access to MRgFUS is not well understood. A recent study found that after approval and media coverage, surgical referrals for tremor increased dramatically, though many individuals were better served with medication adjustment or deep brain stimulation (DBS). Whether certain social drivers of health (SDoH) covary with MRgFUS access is unknown, but is observed in DBS and other movement disorders.

Method: The sample included individuals referred for MRgFUS at a single center. We coded demographics (sex, age, ethnicity, race), SDoH (Area Deprivation Index [ADI], education, occupation, insurance), and clinical characteristics (referral/workup diagnosis, treatment recommendation). Analysis included descriptives, chi-square, and t-tests/ANOVAs.

Results: A total of 134 participants were analyzed. Most were male (71.6%), non-Hispanic white (93.5%), highly educated (M_YearsEdu=15.2), well-insured (97.5% Medicare and/or private insurance), with complex occupations (64.8% managerial/professional), and lived in advantaged communities (M_ADInational=40.9). Essential Tremor (ET) was the primary referral reason (73.8%), followed by Parkinson’s (21.9%), with 70.1% having ET confirmed during workup. MRgFUS was the most recommended intervention post workup (77.4%), followed by DBS (9.7%), medication-adjustment (2.6%), and non-candidacy (5.2%). Analyses of workup disposition relative to demographic/SDoH variables revealed a significant impact for age (p=0.005), with older patients being more likely to undergo MRgFUS. No significant differences were found for ADI, education, sex, race, ethnicity, insurance status, or occupation.

Conclusion: Relative to earlier studies, a higher proportion of people referred for surgical workup received MRgFUS. Save for age, there is minimal disparity in MRgFUS recommendation relative to demographic and SDoH indicators. This should be hedged by the fact that most referred individuals were advantaged, and we cannot rule out upstream disparities in referral.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/equity-in-access-to-mri-guided-focused-ultrasound-for-movement-disorders-patient-characteristics-and-treatment-disposition/