MRgFUS thalamotomy is an image guided procedure with no incision. MRgFUS integrates ultrasonic waves with magnetic resonance imaging for therapeutic transcranial ablation ( 13). GKT was developed as a relatively less invasive thalamotomy method, but suffered from unpredictable lesion size limitation and time taken for the clinical benefit to become apparent ( 12). However, there are several drawbacks related to its use, such as implant related complications and the requirement of frequent hospital visits for programming ( 10, 11). The higher risk of side effects eventually led clinicians to consider DBS as a choice for surgical treatment of ET ( 7– 9). Stereotactic radiofrequency ablation of basal ganglia and thalamic structures, including the VIM nucleus was one of the first surgical interventions to be offered to ET patients ( 6). These patients can be good candidates for surgical treatments such as deep brain stimulation, radiofrequency thalamotomy, focused ultrasound thalamotomy, or gamma knife thalamotomy (GKT). Medications such as propranolol and primidone are the first line therapy, but many patients with ET become drug refractory ( 5). Although not life threatening, it carries significant morbidity due to functional impairment from loss of hand function ( 5). Analysis of other complications further revealed a decreasing trend on follow up.Įssential tremor (ET) is the most common form of adult movement disorder ( 1, 2), with an estimated prevalence of 4–6% ( 3, 4). Use of DTI based targeting revealed a significant reduction in post procedure ataxia related complications as compared to traditional targeting techniques. A significant reduction ( p = 0.03) in immediate ataxia related complications was seen with DTI targeting.Ĭonclusion: MRgFUS for ET seems to be an effective procedure for relieving unilateral tremor. The immediate pooled proportion of ataxia was 50%, while it was 20% for sensory complications, which, respectively, declined to 31 and 13% on long term follow up. Head pain and dizziness were the most in procedure complications. A significant difference was observed in the pooled standard mean difference between the pre and postoperative total CRST score ( p-value < 0.001 and 0.0002), hand score ( p-value 0.03 and 0.02) and the disability at 12 months ( p-value 0.01). DTI based targeting was utilized in six cohorts. Results: We found 29 studies evaluating 617 patients. The post procedure changes in the Clinical Rating Scale for Tremor (CRST) score, hand score, disability and quality of life scores were analyzed. Methods: A systematic literature review was done. The objective of this review was to analyze the efficacy and the safety profile of MRgFUS for ET. 4Department of Neurosurgery, Bangalore Medical College, Bangalore, Indiaīackground: Magnetic resonance guided focused ultrasound (MRgFUS) is a relatively novel technique to treat essential tremor (ET).3Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.2Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.1Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, India.
Mohit Agrawal 1 †, Kanwaljeet Garg 2 * †, Raghu Samala 2, Roopa Rajan 3, Vikas Naik 4 and Manmohan Singh 2
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