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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.
Contributors Design of the work: CG-S. Patient data: CG-S, PG, RP, IO, LVD, RM-F, JM-M, DM-M, FA-F. Focused ultrasound: RM-F, FH-F, JAP-P, MdA, RR-R, EdL. Analysis: CG-S. Interpretation of data for the work: CG-S, PG, IO, JAO. Drafting the work: CG-S. Revising the work critically for important intellectual content: all authors. Final approval of the version to be published: JAO.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Ethics approval The Local Ethics Committee for Medical Research approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.