Objective: To report clinical outcomes of a MRgFUS thalamotomy of ventral-oralis complex (Vo) (n=1) or ventral intermediate (Vim) (n=2) nucleus in three patients with hands tremor and dystonia.

Background: The efficacy of MRgFUS for unilateral thalamotomies in ET has been reported in several studies. In addition, stereotactic ablation and deep brain stimulation of the thalamic Vo nucleus have shown to be successful in focal dystonia. Few studies with MRgFUS thalamotomy in hands tremor and dystonia have been conducted.

Method: We describe three cases of unilateral hands and tremor dystonia who have undergone unilateral MRgFUS thalamotomy: a 45-year-old female (targeted in Vim), a 91-year-old male (targeted in Vim) and a 50-year-old male (targeted in Vo). They were followed up at 3 and 6 months. Assessments included change from baseline of rest, postural and kinetic tremor as well as improvement of dystonic postures of the hand of the treated side. Results are presented as a percentage of change from baseline to last follow-up. Treatment-related adverse events (AE) were registered. Clinical global impression (CGI) of patients was also assessed.

Results: Significant improvements from baseline were evident for the treated side in all modalities of tremor: rest (100%), postural (100%) and kinetic (91%). Dystonic postures of the contralateral side of the lesion were also improved (100%). Although a mild dysmetria was observed at three months in the 91-year-old male, no AE were reported at six months in the other two patients. CGI impression of the three patients was much improved.

Conclusion: Our experience suggests that the thalamotomy of Vo or Vim in hands tremor and dystonia has positive outcomes. More studies with higher samples are needed to support these results.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/treatment-with-magnetic-resonance-guided-focused-ultrasound-mrgfus-thalamotomy-in-patients-with-hands-tremor-and-dystonia-a-series-of-three-cases/