TY - JOUR T1 - Bilateral staged magnetic resonance-guided focused ultrasound thalamotomy for the treatment of essential tremor: a case series study JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry DO - 10.1136/jnnp-2020-325278 SP - jnnp-2020-325278 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 Y1 - 2021/04/27 UR - http://jnnp.bmj.com/content/early/2021/04/26/jnnp-2020-325278.abstract N2 - 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. ER -