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Updated: Sep 16, 2025
MRI-guided Focused Ultrasound Thalamotomy for Patients with Medically-refractory Essential Tremor
Published on: December 13, 2017
Magnetic resonance-guided ultrasound thalamotomy for essential tremor: a review
Emmanuel De Schlichting1, Ying Meng1,2,3, Yuexi Huang1
1Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Harquail Centre for Neuromodulation, Toronto, ON, Canada.
Introduction:
Essential tremor (ET) is a common neurological disorder characterized by involuntary, rhythmic shaking, primarily of the hands. While not life-threatening, ET significantly impairs quality of life. Pharmacological treatments, like beta-blockers or anticonvulsants, often have limited efficacy, leading patients to more aggressive alternatives such as surgical intervention. Recently, magnetic resonance-guided focused ultrasound has emerged as an alternative to surgical procedures, offering incisionless lesioning of the thalamus, resulting in immediate and sustained tremor reduction.
Areas Covered:
This review explores the MRgFUS technique in the treatment of ET, reviewing clinical efficacy, safety, and procedural advances. A literature search was conducted using PubMed for articles published between January 2015 and March 2024, with the terms: 'MRgFUS,' 'essential tremor,' 'focused ultrasound thalamotomy,' and 'bilateral thalamotomy.' Key points such as patient selection, skull density ratio, monitoring, thermal effects and tractography are discussed.
Expert Opinion:
MRgFUS has transformed the treatment of ET by providing a precise, incisionless alternative now included in clinical guidelines. Challenges such as SDR limitations or restricted approved-indications limit its extended use. Advances in targeting, thermometry and other biological effects such as histotripsy could expand accessibility and indications. By 2035, MRgFUS could become a standard outpatient procedure for ET and other brain disorders.
