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Functional tremor developing after successful MRI-guided focused ultrasound thalamotomy for essential tremor
  1. Sohaila Alshimemeri1,2,
  2. Daniel Vargas-Méndez1,3,
  3. Robert Chen1,
  4. Nir Lipsman4,5,
  5. M L Schwartz4,5,
  6. Andres M Lozano6,7,
  7. Alfonso Fasano1,7,8
  1. 1Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN, Toronto Western Hospital, Toronto, Ontario, Canada
  2. 2Neurology Unit, Department of Medicine, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
  3. 3Division of Neurology, Clinica de Merida, Merida, Yucatan, Mexico
  4. 4Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5Department of surgery, University of Toronto, Toronto, Ontario, Canada
  6. 6Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada
  7. 7University of Toronto, Toronto, Ontario, Canada
  8. 8Krembil Brain Institute, Toronto, Ontario, Canada
  1. Correspondence to Professor Alfonso Fasano, Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, UHN, Toronto Western Hospital, Toronto, Canada; alfonso.fasano{at}


Objective To describe a case of functional tremor occurring after a successful MR-guided focused ultrasound thalamotomy (MRgFUS) for essential tremor.

Methods A 71-year-old right-handed man with essential tremor was referred to us for consideration of deep brain stimulation surgery for worsening bilateral upper limb tremor after a successful left MRgFUS for essential tremor.

Results On clinical exam, signs compatible with a functional tremor were noted, including entertainability and suppressibility. Electrophysiological studies were consistent with essential tremor and superimposed tremor fulfilling the laboratory-supported criteria for functional tremor.

Discussion We describe the first reported case of a functional movement disorder occurring after successful MRgFUS procedure for essential tremor. Recognising this entity and its development after such therapeutic interventions is essential to avoid further unnecessary invasive therapies.


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  • Contributors SA and AF designed and conceptualised the study, had a major rule in data acquisition and drafting/revising the manuscript. DV-M and RC had a major role in analysis and interpretation of the data. AML, NL and MLS had a major role in revising the manuscript for intellectual content.

  • Competing interests AML is consultant to Medtronic, Abbott, Boston Scientific and Insightec, and a Scientific Director at Functional Neuromodualtion. Other authors report no conflicts.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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