Related Experiment Video
Updated: Mar 15, 2026
MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
Published on: December 13, 2017
A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor
W Jeffrey Elias1, Nir Lipsman1, William G Ondo1
1From the University of Virginia Health Sciences Center, Charlottesville (W.J.E., B.B.S., D.H., R.F.D.); Toronto Western Hospital (N.L., A.M.L.) and Sunnybrook Health Sciences Centre (M.S., K.H.), Toronto; Methodist Neurological Institute, Houston (W.G.O.); Stanford University School of Medicine, Stanford, CA (P.G., C.H.H., K.B.P.); Yonsei University College of Medicine, Seoul, South Korea (Y.G.K., W.L., J.W.C.); Swedish Neuroscience Institute, Seattle (R.G., J.W., S.R., R.C.); University of Maryland School of Medicine, Baltimore (H.M.E., P.S.F., D.G.); University of Miami School of Medicine, Nicklaus Children's Hospital, Miami (T.S.T.); Brigham and Women's Hospital, Boston (M.T.H., G.R.C.); and Shin-yurigaoka General Hospital, Kawasaki (T.Y.), and Tokyo Women's Medical University, Tokyo (K.A., T.T.) - both in Japan.
Background:
Uncontrolled pilot studies have suggested the efficacy of focused ultrasound thalamotomy with magnetic resonance imaging (MRI) guidance for the treatment of essential tremor.
Methods:
We enrolled patients with moderate-to-severe essential tremor that had not responded to at least two trials of medical therapy and randomly assigned them in a 3:1 ratio to undergo unilateral focused ultrasound thalamotomy or a sham procedure. The Clinical Rating Scale for Tremor and the Quality of Life in Essential Tremor Questionnaire were administered at baseline and at 1, 3, 6, and 12 months. Tremor assessments were videotaped and rated by an independent group of neurologists who were unaware of the treatment assignments. The primary outcome was the between-group difference in the change from baseline to 3 months in hand tremor, rated on a 32-point scale (with higher scores indicating more severe tremor). After 3 months, patients in the sham-procedure group could cross over to active treatment (the open-label extension cohort).
Results:
Seventy-six patients were included in the analysis. Hand-tremor scores improved more after focused ultrasound thalamotomy (from 18.1 points at baseline to 9.6 at 3 months) than after the sham procedure (from 16.0 to 15.8 points); the between-group difference in the mean change was 8.3 points (95% confidence interval [CI], 5.9 to 10.7; P<0.001). The improvement in the thalamotomy group was maintained at 12 months (change from baseline, 7.2 points; 95% CI, 6.1 to 8.3). Secondary outcome measures assessing disability and quality of life also improved with active treatment (the blinded thalamotomy cohort)as compared with the sham procedure (P<0.001 for both comparisons). Adverse events in the thalamotomy group included gait disturbance in 36% of patients and paresthesias or numbness in 38%; these adverse events persisted at 12 months in 9% and 14% of patients, respectively.
Conclusions:
MRI-guided focused ultrasound thalamotomy reduced hand tremor in patients with essential tremor. Side effects included sensory and gait disturbances. (Funded by InSightec and others; ClinicalTrials.gov number, NCT01827904.).
More Related Videos
08:33Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
Published on: January 5, 2024
08:38Author Spotlight: Integration of Fiber Photometry and Focused Ultrasound Neuromodulation for Investigating Neural Modulation in Freely Moving Mice
Published on: September 6, 2024