MRI-guided focused ultrasound thalamotomy in non-ET tremor syndromes

Neurology. 2017 Aug 22;89(8):771-775. doi: 10.1212/WNL.0000000000004268. Epub 2017 Jul 26.


Objective: To report the 6-month single-blinded results of unilateral thalamotomy with MRI-guided focused ultrasound (MRgFUS) in patients with tremors other than essential tremor.

Methods: Three patients with tremor due to Parkinson disease, 2 with dystonic tremor in the context of cervicobrachial dystonia and writer's cramp, and 1 with dystonia gene-associated tremor underwent MRgFUS targeting the ventro-intermedius nucleus (Vim) of the dominant hemisphere. The primary endpoint was the reduction of lateralized items of the Tremor Rating Scale of contralateral hemibody assessed by a blinded rater.

Results: All patients achieved a statistically significant, immediate, and sustained improvement of the contralateral tremor score by 42.2%, 52.0%, 55.9%, and 52.9% at 1 week and 1, 3, and 6 months after the procedure, respectively. All patients experienced transient side effects and 2 patients experienced persistent side effects at the time of last evaluation: hemitongue numbness and hemiparesis with hemihypoesthesia.

Conclusions: Vim MRgFUS is a promising, incision-free, but nevertheless invasive technique to effectively treat tremors other than essential tremor. Future studies on larger samples and longer follow-up will further define its effectiveness and safety.

Clinicaltrialsgov identifier: NCT02252380.

Classification of evidence: This study provides Class IV evidence that for patients with tremor not caused by essential tremor, MRgFUS of the Vim improves the tremor of the contralateral hemibody at 6 months.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Functional Laterality
  • High-Intensity Focused Ultrasound Ablation* / adverse effects
  • Humans
  • Magnetic Resonance Imaging, Interventional*
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Single-Blind Method
  • Thalamus / diagnostic imaging*
  • Thalamus / surgery*
  • Treatment Outcome
  • Tremor / diagnostic imaging*
  • Tremor / surgery*

Associated data