PT  - JOURNAL ARTICLE
AU  - Raúl Martínez-Fernández
AU  - Sujitha Mahendran
AU  - Jose Angel Pineda-Pardo
AU  - Lukas L Imbach
AU  - Jorge U Máñez-Miró
AU  - Fabian Büchele
AU  - Marta del Álamo
AU  - Rafael Rodriguez-Rojas
AU  - Frida Hernández-Fernández
AU  - Beat Werner
AU  - Michele Matarazzo
AU  - Ignacio Obeso
AU  - Lain H Gonzalez-Quarante
AU  - Günther Deuschl
AU  - Lennart Stieglitz
AU  - Christian R Baumann
AU  - Jose A Obeso
TI  - Bilateral staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of essential tremor: a case series study
AID  - 10.1136/jnnp-2020-325278
DP  - 2021 Apr 27
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - jnnp-2020-325278
4099  - http://jnnp.bmj.com/content/early/2021/04/26/jnnp-2020-325278.short
4100  - http://jnnp.bmj.com/content/early/2021/04/26/jnnp-2020-325278.full
AB  - Background Unilateral magnetic resonance-guided focused ultrasound (FUS) thalamotomy is efficacious for the treatment of medically refractory essential tremor (ET). Viability of bilateral FUS ablation is unexplored.Methods Patients diagnosed with medically refractory ET and previously treated with unilateral FUS thalamotomy at least 5 months before underwent bilateral treatment. The timepoints were baseline (before first thalamotomy) and FUS1 and FUS2 (4 weeks before and 6 months after second thalamotomy, respectively). The primary endpoint was safety. Efficacy was assessed through the Clinical Rating Scale for Tremor (CRST), which includes subscales for tremor examination (part A), task performance (part B) and tremor-related disability (part C).Results Nine patients were treated. No permanent adverse events were registered. Six patients presented mild gait instability and one dysarthria, all resolving within the first few weeks. Three patients reported perioral hypoesthesia, resolving in one case. Total CRST score improved by 71% from baseline to FUS2 (from 52.3±12 to 15.5±9.4, p<0.001), conveying a 67% reduction in bilateral upper limb A+B (from 32.3±7.8 to 10.8±7.3, p=0.001). Part C decreased by 81% (from 16.4±3.6 to 3.1±2.9, p<0.001). Reduction in head and voice tremor was 66% (from 1.2±0.44 to 0.4±0.54, p=0.01) and 45% (from 1.8±1.1 to 1±0.8, p=0.02), respectively.Conclusion Bilateral staged FUS thalamotomy for ET is feasible and might be safe and effective. Voice and head tremor might also improve. A controlled study is warranted.