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Updated: Mar 2, 2026

MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
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Revisiting bilateral thalamotomy for tremor.

Jumana Alshaikh1, Paul S Fishman1

  • 1Department of Neurology, University of Chicago Pritzker School of Medicine, Chicago, IL, 60637, United States.

Clinical Neurology and Neurosurgery
|May 16, 2017
PubMed
Summary

MRI guided focused ultrasound surgery (MRgFUS) offers a potential solution for bilateral essential tremor treatment. Careful patient selection and staged procedures are key to minimizing risks like speech and balance issues.

Keywords:
Essential tremorFocused ultrasoundFusMRgFUSParkinson’s diseaseThalamotomyTremorVim

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Neurology

Background:

  • MRI guided focused ultrasound surgery (MRgFUS) is FDA-approved for unilateral essential tremor (ET).
  • Bilateral thalamic ablation requires careful consideration due to historical complications.
  • Previous bilateral thalamotomies, especially in Parkinson's disease, showed high rates of speech and balance issues.

Purpose of the Study:

  • To evaluate the safety and feasibility of bilateral MRgFUS for essential tremor.
  • To address concerns regarding potential worsening of speech and balance after bilateral procedures.
  • To inform the application of MRgFUS to bilateral ET treatment.

Main Methods:

  • Review of historical data on bilateral thalamic ablation.
  • Analysis of contemporary experience with bilateral thalamotomy in ET patients.
  • Consideration of MRgFUS as a minimally invasive bilateral treatment option.

Main Results:

  • Early bilateral thalamotomies had high complication rates (approx. 30% dysarthria/ataxia), particularly in Parkinson's disease patients.
  • Contemporary bilateral thalamotomy in ET patients shows significantly lower complication rates (approx. 5%).
  • MRgFUS offers a non-incisional approach for potential bilateral ET treatment.

Conclusions:

  • Bilateral MRgFUS may be safely applied to ET patients with axial or bilateral limb involvement.
  • Staged procedures and exclusion of patients with baseline or transient speech/balance deficits are crucial.
  • MRgFUS has the potential to improve outcomes for bilateral ET beyond unilateral treatments.