Objective: To prospectively compare 1 year clinical efficacy and safety following RF and MRgFUS thalamotomy in essential tremor.

Background: Ventral intermediate nucleus (VIM) thalamotomy is an established treatment for medically refractory essential tremor. Traditionally, these lesioning procedures were performed using radiofrequency (RF) ablation, but the introduction of MR-guided focused ultrasound (MRgFUS) has significantly increased thalamotomy procedures worldwide. However, there has been no comparative studies of real-world outcomes.

Method: We prospectively evaluated consecutive patients with medication-refractory essential tremor undergoing unilateral VIM RF and MRgFUS thalamotomy between 2022 and 2025. Targeting was performed through direct visualisation of the VIM on FAT1-weighted MRI sequence. Tremor severity was assessed using treated-hand scores derived from Part A (resting, postural, action/intention tremor) and Part B (handwriting, drawing, pouring) of the Clinical Rating Scale for Tremor (CRST). Quality of life (QoL) was assessed using the Quality of Life in Essential Tremor Questionnaire (QUEST). Outcomes were evaluated preoperatively and at 1 year. Side effects were systematically recorded.

Results: Thirty-four patients were included (MRgFUS, n=20; RF, n=14). At 1 year, treated-hand scores improved by 72.7% following MRgFUS (19.5 (IQR 6.25) vs 6.5 (IQR 3.5)) and 70.9 % following RF (18.5 (IQR 12.25) vs 4.0 (IQR 9.0)) thalamotomy. QoL improved by 68.4% following MRgFUS (32.78 (IQR 33.2) vs 11.8 (IQR 19.7)) and 75.5% following RF (56.39 (IQR 35.1) vs 18.6 (IQR 24.4)) . There was no statistically significant difference in tremor or QoL improvement between MRgFUS and RF.

The most frequently reported persistent side effects were gait impairment (8/20 MRgFUS; 5/14 RF), incoordination (4/20 MRgFUS; 2/14 RF) and dysgeusia (4/20 MRgFUS; 1/14 RF), paraesthesia (3/20 MRgFUS; 1/14 RF) and dysarthria (2/20 MRgFUS; 1/14 RF). Importantly, no severe side effects affecting activities of daily living were observed in either cohort at 1 year.

Conclusion: There was comparable improvement in tremor and QoL between patients undergoing RF and MRgFUS thalamotomy after 1 year, with no severe persistent side effects. These findings support the effectiveness of both lesioning approaches in contemporary clinical practice.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/one-year-outcomes-of-radiofrequency-thalamotomy-versus-mr-guided-focused-ultrasound-a-prospective-single-centre-comparative-study/