Objective: To describe the safety and efficacy of focused ultrasound thalamotomy (FUS) in a cohort of patients with essential tremor (ET) within the Spanish public health system.

Background: Up to 50% of ET patients presents a disabling refractory tremor. Magnetic resonance-guided FUS improves tremor in ET.

Method: Patients with ET who underwent unilateral FUS thalamotomy between February 2022 and January 2023 were included. Patients were assessed pre-procedure, post-procedure and at follow-up (FU) visits (7-day, 3-months and 6-months). Tremor was assessed using the Clinical Rating Scale for tremor (CRST) parts A, B and C, as well as a subscore for the tasks specific to the treated side. Adverse events were collected.

Results: Eighty-two patients were included (72 had available data for 7-day visit, 50 for 3-months and 26 for 6-months). Mean age at the procedure was 72.476±7.40 years, mean disease duration of 18.33±10.34 years. Thalamotomy was performed in the left VIM in 93.90% of patients. Patients underwent on average 7.06±3.56 sonications (range 4-13), with a maximal energy reached at treatment sonications of 14270J(3017-43915), and an averaged maximal temperature of 57.95ºC(48-66ºC). After thalamotomy, an improvement of 88.2% and 77.8% was observed in the CRST subscore of the treated side at 7-day and 3-months, respectively (18.47±5.03 preprocedure, 2.18±3.99 at 7-day, 4.10±4.69 at 3-months). The CRST part A score decreased from 16.28±6.85 preprocedure to 6.46±4.67 postprocedure, and maintained at 6-months (9.6±4.05). CRST parts B and C also decreased from baseline to FU visits (B:25.58±7.06 preprocedure, 9.56±5.96 postprocedure, 13.86±6.90 at 3-months; and 18.1±5.50 at 6-months; C: 13.02±7.40 preprocedure, 4.0±4.08 at 3-months, 6.2±3.9 at 6-months. The most frequent adverse events related to the procedure were headache (49.43%), dizziness (49.43%) and nausea (17.24%), and related to thalamotomy: 13(14.94%) gait instability, 12(13.79%) dysarthria, 4(4.6%) ataxia, 3(3.45%) dysmetria, 2(2.3%) mild weakness and 1(1.15%) dysgeusia. At 3-months, 34% of patients presented any adverse event, being instability (23.53%), dysmetria (11.76%), and dysarthria (2.94%) the most frequent.

Conclusion: Unilateral FUS thalamotomy for treatment of disabling tremor in the public health system shows a reasonable safety profile and improves the tremor of patients with ET.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/safety-and-efficacy-of-focused-ultrasound-thalamotomy-in-essential-tremor-a-real-scenario-within-the-public-health-system/