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Updated: Dec 31, 2025
MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
Published on: December 13, 2017
Tremor Relief and Structural Integrity after MRI-guided Focused US Thalamotomy in Tremor Disorders
Gil Zur1, Orit H Lesman-Segev1, Ilana Schlesinger1
1From the Department of Neuroscience, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, 1 Efron St, Haifa 31096, Israel (G.Z., O.H.L.S., I.K., M.Z.); Departments of Radiology (G.Z., O.H.L.S., D.G., A.E.), Neurology (I.S.), and Neurosurgery (A.S., M.Z.), Rambam Health Care Campus, Haifa, Israel; Department of Neurobiology, Faculty of Life Science, Tel Aviv University, Tel Aviv, Israel (Y.A.); and Memory and Aging Center, Department of Neurology, University of California-San Francisco, San Francisco, Calif (O.H.L.S.).
MRI-guided focused ultrasound thalamotomy causes white matter changes in essential tremor and Parkinson disease patients. Lower pre-treatment fractional anisotropy in the motor thalamus correlated with better tremor relief.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- MRI-guided focused ultrasound (MRgFUS) thalamotomy treats tremor disorders by targeting the ventral intermediate nucleus.
- Understanding the impact of MRgFUS on white matter integrity is crucial for evaluating treatment outcomes.
Purpose of the Study:
- To assess white matter integrity changes following MRgFUS thalamotomy.
- To correlate these changes with clinical outcomes in patients with essential tremor (ET) and Parkinson disease (PD).
Main Methods:
- Diffusion-tensor imaging (DTI) and fiber tractography were used to evaluate white matter integrity before and at multiple time points after MRgFUS thalamotomy.
- Clinical assessments of tremor and quality of life were performed pre- and post-treatment.
- Statistical analyses included repeated measures ANOVA and Skillings-Mack tests with Bonferroni correction.
Main Results:
- MRgFUS thalamotomy led to significant long-term white matter damage in the ablated core and the thalamus-to-red nucleus tract.
- A negative correlation was found between motor thalamus fractional anisotropy (FA) one day post-ablation and tremor improvement in both ET and PD.
- Lower pre-treatment FA in the motor thalamus was associated with better tremor relief in ET patients.
Conclusions:
- MRgFUS thalamotomy induces both short- and long-term white matter alterations.
- DTI reveals lasting damage in the ablation zone and related tracts, correlating with clinical response.
- Pre-treatment white matter integrity, specifically FA, is a predictor of treatment efficacy for tremor.
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