Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Medication-Refractory Essential Tremor
DOI:
https://doi.org/10.5281/zenodo.22310554Keywords:
Essential tremor, Focused ultrasound, Thalamotomy, Ventral intermediate nucleus, Movement disorder surgeryAbstract
Background: Essential tremor is among the most common adult movement disorders. A substantial minority of patients become
refractory to first-line pharmacotherapy. Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy offers an
incisionless alternative to deep brain stimulation and radiofrequency thalamotomy. Objective: To synthesise published evidence on unilateral and staged bilateral MRgFUS thalamotomy for medication-refractory essential tremor.Methods: Narrative review of pilot and pivotal trials, long-term follow-up studies, comparative literature, and mechanistic imaging studies. Findings: The pivotal sham-controlled trial showed 47% tremor/motor improvement at three months versus 0.1% with sham. Benefit persisted through five years. Numbness and gait disturbance are common adverse events. Skull density ratio constrains candidacy in some patients. Staged bilateral treatment adds benefit with additional risk. Conclusions: MRgFUS thalamotomy is a durable, well-tolerated option for carefully selected patients, complementing rather than replacing deep brain stimulation and radiofrequency approaches.
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