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Cognitive safety after unilateral magnetic resonance-guided focused ultrasound thalamotomy for essential tremor
  1. Carmen Gasca-Salas1,2,
  2. Pasqualina Guida1,
  3. Rosanna Piredda1,
  4. Ignacio Obeso1,2,
  5. Lydia Vela Desojo1,2,3,
  6. Raúl Martínez-Fernández1,2,
  7. Frida Hernández-Fernández1,
  8. Jorge Máñez-Miró1,
  9. José A Pineda-Pardo1,2,
  10. Marta del Álamo1,2,
  11. Rafael Rodriguez-Rojas1,2,
  12. David Mata-Marín1,2,
  13. Fernando Alonso-Frech1,2,4,
  14. Esther de Luis5,
  15. Jose Angel Obeso1,2
  1. 1 Centre for Integrative Neuroscience AC, HM Puerta del Sur, CEU San Pablo University, Madrid, Spain
  2. 2 Centro de Investigacion Biomedica en Red sobre Enfermedades Neurodegenerativas, Madrid, Spain
  3. 3 Neurology, Hospital Fundación Alcorcon, Alcorcon, Spain
  4. 4 Hospital Clinico Universitario San Carlos, Madrid, Spain
  5. 5 Radiology Department, University Hospital HM Puerta del Sur, Madrid, Spain
  1. Correspondence to Dr Carmen Gasca-Salas, Centro Integral en Neurociencias (CINAC), University Hospital HM Puerta del Sur, CEU-San Pablo University, Móstoles, Madrid 28938, Spain; cgasca.hmcinac{at}

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Essential tremor (ET) is the most common movement disorder, affecting 1% of the population worldwide. There is sound evidence that medically refractory tremor improves with thalamotomy and deep brain stimulation (DBS) targeting the thalamic ventralis intermedius nucleus (VIM). In the last few years, the incisionless technique of magnetic resonance-guided focused ultrasound (MRgFUS) has been demonstrated to be an effective procedure for unilateral thalamotomy,1 with a positive profile with regard to side effects.

The thalamus is involved in cognitive functions such as attention/executive control, memory and language. Focal ablation of the thalamus, even when targeting a sensorimotor region as the VIM, raises question about potential cognitive side effects. After unilateral VIM-DBS in 40 patients with ET, Fields et al 2 showed statistically significant improvements in visuoperceptual function and verbal memory. There was no significant decline in any measure, but four patients with preoperative low verbal fluency showed a further decline. Most studies have shown reduced verbal fluency under active VIM-DBS.2–4 Since focused ultrasound thalamotomy is a less invasive procedure, we hypothesised that the risk of procedure-related cognitive decline is further reduced.


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