This page provides relevant information about the safety and outcomes of bilateral staged MRgFUS thalamotomy as a treatment option for essential tremor, based on studies by Scantlebury et al. (2023) and Fukutome et al. (2022). Additionally, it includes information from Precision Brain Spine and Pain, a leading institution specialising in MRgFUS treatment. Please read this information carefully before discussing it with your healthcare provider.

Introduction:

Bilateral staged MR-guided focused ultrasound (MRgFUS) thalamotomy is an advanced treatment approach for essential tremor. It involves treating both sides of the brain’s thalamus separately, with a period of assessment between treatments. Studies by Scantlebury et al. (2023) and Fukutome et al. (2022) provide valuable insights into the safety and outcomes of this procedure. Traditionally, many movement disorder specialists were reluctant to treat both sides of the brain, particularly at the same time, because data suggested a much higher risk of balance issues when this was done. With the passage of time, a small number of clinics, including Precision Brain Spine and Pain, have started to offer the second side procedure, albeit months or years after the first side was done. The purpose of treating the second side is to offer the patient a reduction in tremor on both sides of the body, rather than just on one side.

Safety and Outcomes (Scantlebury et al., 2023):

In a prospective, open-label trial, 16 consecutive patients with medication-refractory essential tremor (mrET) who had undergone MRgFUS thalamotomy were evaluated. The key findings include:

1. Tremor Severity Improvement. Tremor severity in the targeted hand improved significantly after each MRgFUS treatment (P < 0.001), while the untargeted-hand tremor had no significant change.
2. Adverse Events (AEs). A total of 21 AEs were identified, with 81% rated as mild, consistent with other trials. No severe AEs were reported. AEs included short-lasting leg/shoulder pain, nausea, headache, pin site pain, and scalp bruising, with most being transient and of mild to moderate severity. Four patients reported mild to moderate disequilibrium, including one fall, after MRgFUS. There was no limb ataxia detected. Speech intelligibility and dysarthria showed no significant change post-MRgFUS, and no significant changes in cognitive function were detected.
3. Quality of Life Improvement. Despite mild to moderate AEs, patients’ function and quality of life improved further, as measured by the Clinical Rating Scales for Tremor (CRST) Part C disability scores and the Quality of Life in ET (QUEST) questionnaire. This indicates an improvement in patients’ ability to perform tasks that require two hands.

Safety and Outcomes (Fukutome et al., 2022):

In a retrospective study, Fukutome and colleagues investigated the efficacy and safety of staged bilateral ventral intermediate nucleus thalamotomy for refractory essential tremor using magnetic resonance imaging-guided focused ultrasound. The second lesion was created asymmetrically to the first lesion, and the mean interval between the two operations was 28 months.

Their key findings include:

1. Significant improvements were observed in the Clinical Rating Scale for Tremor total scores and Clinical Rating Scale for Tremor part C scores after the second operation.
2. Only one patient had permanent adverse events of slight dysarthria and discomfort in the tongue. No patient experienced dysphagia or cognitive dysfunction after the second operation.
3. Four out of five patients were satisfied with the results of the bilateral treatment, including the patient who had permanent adverse events.

Precision Brain Spine and Pain:

At Precision Brain Spine and Pain, a leading institution specialising in MRgFUS treatment, many of our patients who underwent MRgFUS for tremor are now returning to have the second side done. Our results are very encouraging and are consistent with reported results in the scientific literature.

We are frequently seeing:

1. Significant functional improvements in daily activities.
2. Enhanced quality of life, including improved ability to perform tasks requiring two hands.
3. High patient satisfaction levels in these patients.

We understand that the decision to proceed with the second side of the treatment is important. To ensure the best outcomes, we currently recommend patients wait at least 4-6 months before having the second side done. This interval allows for optimal recovery and assessment between treatments, contributing to the overall success of the procedure.

Choosing the Right Clinic:

When considering MRgFUS thalamotomy for essential tremor, it is crucial to receive advice and treatment from an experienced clinic with a strong track record in both deep brain stimulation and MRgFUS. Expertise Matters, and is required across a broad range of specialties:

1. Fellowship-Trained Functional and Stereotactic Neurosurgeons: An experienced team of fellowship-trained functional and stereotactic neurosurgeons specialising in MRgFUS ensures precise targeting and safe procedures.
2. Neurologists: Expert neurologists can provide comprehensive pre- and post-operative care, optimising treatment outcomes.
3. Neuroradiologists: These specialists play a vital role in guiding the procedure with real-time imaging, enhancing accuracy.
4. MR Technicians: Well-trained and skilled MR technicians are essential for obtaining high-quality imaging during MRgFUS. This contributes to the procedure’s safety and effectiveness.
5. Nursing Team: Nurses are a crucial part of the care team, providing attentive and compassionate care throughout your treatment journey.

Benefits of Choosing an Experienced Clinic:

Safety: A clinic with years of experience in both MRgFUS and Deep Brain Stimulation should be better equipped to minimise risks and manage potential complications.

Precision: Expertise ensures accurate targeting of the thalamus, maximising the effectiveness of the treatment.

Personalised Care: Experienced teams tailor treatment plans to each patient’s unique needs, enhancing the overall patient experience.

MRgFUS at Precision Brain Spine and Pain:

At Precision Brain Spine and Pain, we pride ourselves on our extensive experience and expertise in MRgFUS and deep brain stimulation. Our multidisciplinary team includes expert fellowship-trained functional and stereotactic neurosurgeons, neurologists, neuroradiologists, highly skilled MR technicians, and a dedicated nursing team. We are committed to providing the highest level of care for patients with essential tremor.

Summary:

The studies by Scantlebury et al. (2023) and Fukutome et al. (2022) collectively demonstrate that bilateral staged MRgFUS thalamotomy for essential tremor is a promising and effective treatment option. While some mild to moderate adverse events were observed, they were generally transient and did not significantly affect patients’ daily lives. The procedure led to significant tremor improvement and enhanced quality of life for most patients with medically refractory Essential Tremor.

Please remember that this page provides general information and does not replace personalised advice from your healthcare provider. Always consult with your healthcare team to make informed decisions about your treatment options.

References:

Scantlebury N, Rohringer CR, Rabin JS, Yunusova Y, Huang Y, Jones RM, Meng Y, Hamani C, McKinlay S, Gopinath G, Sewell IJ, Marzouqah R, McSweeney M, Lam B, Hynynen K, Schwartz ML, Lipsman N, Abrahao A. “Safety of Bilateral Staged Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor.” Mov Disord Clin Pract. 2023 Sep 15;10(10):1559-1561. doi: 10.1002/mdc3.13882

Fukutome K, Hirabayashi H, Osakada Y, Kuga Y, Ohnishi H. “Bilateral Magnetic Resonance Imaging-Guided Focused Ultrasound Thalamotomy for Essential Tremor.” Stereotact Funct Neurosurg. 2022;100(1):44–52. doi: 10.1159/000518662.