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Comparison between deep brain stimulation and magnetic resonance-guided focused ultrasound in the treatment of essential tremor: a systematic review and pooled analysis of functional outcomes
  1. Martina Giordano1,
  2. Valerio Maria Caccavella1,
  3. Ismail Zaed2,
  4. Livia Foglia Manzillo3,
  5. Nicola Montano1,
  6. Alessandro Olivi1,
  7. Filippo Maria Polli1
  1. 1 Department of Neurosurgery, University Hospital Agostino Gemelli, Roma, Italy
  2. 2 Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano, Italy
  3. 3 Department of Neurosurgery, Humanitas University, Milan, Italy
  1. Correspondence to Mr Valerio Maria Caccavella, Department of Neurosurgery, University Hospital Agostino Gemelli, Roma 00168, Italy; valeriom.caccavella{at}


The current gold standard surgical treatment for medication-resistant essential tremor (ET) is deep brain stimulation (DBS). However, recent advances in technologies have led to the development of incisionless techniques, such as magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy. The authors perform a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to compare unilateral MRgFUS thalamotomy to unilateral and bilateral DBS in the treatment of ET in terms of tremor severity and quality of life improvement. PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and SCOPUS databases were searched. 45 eligible articles, published between 1990 and 2019, were retrieved. 1202 patients were treated with DBS and 477 were treated with MRgFUS thalamotomy. Postoperative tremor improvement was greater following DBS than MRgFUS thalamotomy (p<0.001). A subgroup analysis was carried out stratifying by treatment laterality: bilateral DBS was significantly superior to both MRgFUS and unilateral DBS (p<0.001), but no significant difference was recorded between MRgFUS and unilateral DBS (p<0.198). Postoperative quality of life improvement was significantly greater following MRgFUS thalamotomy than DBS (p<0.001). Complications were differently distributed among the two groups (p<0.001). Persistent complications were significantly more common in the MRgFUS group (p=0.042). While bilateral DBS proves superior to unilateral MRgFUS thalamotomy in the treatment of ET, a subgroup analysis suggests that treatment laterality is the most significant determinant of tremor improvement, thus highlighting the importance of future investigations on bilateral staged MRgFUS thalamotomy.

  • tremor
  • surgery
  • ultrasound
  • movement disorders
  • systematic reviews

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  • MG and VMC contributed equally.

  • Contributors IZ, VMC and MG were involved in the design and conception of this manuscript. IZ, VMC, LFM and MG performed the literature search. VMC and MG conducted analysis. MG, NM and FMP compiled the primary manuscript. MG and VMC compiled the tables. AO critically revised the manuscript. All authors have approved the manuscript as it is written.

  • 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 Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.