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Staged bilateral MRgFUS thalamotomy associated with tremor reduction in medication-refractory essential tremorSecond ultrasound brain procedure shows tremor improvement in small study

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Key Takeaway
Consider staged bilateral MRgFUS thalamotomy for selected ET patients, noting evidence is from a small observational cohort.

This study combined a meta-analysis with a prospective single-center observational cohort of 15 patients (60% men, mean age 74.1 years) undergoing staged bilateral Magnetic Resonance-guided Focused Ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor. The primary outcome was the longitudinal change in Clinical Rating Scale for Tremor (CRST) A+B scores for the treated hand 12 months after the second procedure. No comparator group was reported.

At 12-month follow-up, the CRST A+B score for the treated hand decreased from 21.0 to 8.8, representing a 58% reduction. The CRST C (functional disability) score decreased by 74.2% (from 7.3 to 1.9), and the Quality of Life in Essential Tremor (QUEST) score improved by 68.7% (from 30.5 to 9.5). Head tremor was reduced by 73.8% and voice tremor by 40.3%. Cognition was globally preserved, though a selective decline in verbal episodic memory was noted.

The safety profile was described as manageable, with adverse events reported as predominantly mild (95.2%) and transient (88%). The rate of serious adverse events was not reported. Key limitations were not explicitly detailed in the provided data, but the study's design as a small, single-center observational cohort without a control group and the lack of reported statistical significance measures (p-values, confidence intervals) constrain the strength of conclusions. The findings support the potential role of this procedure as a therapeutic option in carefully selected patients but do not establish causation or broad generalizability.

Researchers studied a second ultrasound brain procedure for people with essential tremor, a condition that causes shaking that doesn't respond well to medication. The study followed 15 patients at one medical center who had already undergone one procedure and were getting a second one on the other side of the brain. They measured tremor severity using standard rating scales before and for 12 months after the second procedure.

The study found that after the second procedure, scores measuring hand tremor improved by about 58%, and scores measuring how much tremor affects daily life improved by about 69%. Head and voice tremor also improved. Most side effects were reported as mild and temporary. However, the researchers noted a selective decline in verbal memory for some patients one year after the procedure, while other thinking skills were preserved.

It's important to be careful with these results. This was a small, observational study at a single center without a comparison group, so we cannot say the procedure caused the improvements. The findings suggest this staged approach might be a potential option for some carefully selected patients, but larger, more rigorous studies are needed to confirm the benefits and understand the long-term risks, especially regarding memory.

What this means for you:
A second ultrasound procedure was linked to less tremor in a small study, but more research is needed to confirm safety and benefits.

Study Details

Study typeMeta analysis
EvidenceLevel 1
Follow-up12.0 mo
PublishedApr 2026
View Original Abstract ↓
BACKGROUND: Staged bilateral Magnetic Resonance-guided Focused Ultrasound (MRgFUS) thalamotomy is an incisionless option for medication-refractory essential tremor (ET). While the efficacy and safety of unilateral MRgFUS are established, evidence for bilateral treatment remains limited. OBJECTIVE: To evaluate the efficacy and safety of staged bilateral MRgFUS in a prospective single-centre observational cohort and to perform a systematic review and meta-analysis of the literature. METHODS: Consecutive ET patients undergoing second-side MRgFUS were prospectively assessed. The primary efficacy endpoint was the longitudinal change in Clinical Rating Scale for Tremor (CRST) A + B scores for the treated hand after FUS2, while safety was evaluated by collecting and grading adverse events (AEs). A systematic review identified published bilateral MRgFUS series; efficacy data were meta-analysed, while AEs were reported descriptively. RESULTS: Fifteen patients (60% men; mean age 74.1 ± 8.9 years) underwent FUS2 28.9 ± 22.5 months after first-side treatment. At the 12-month evaluation, CRST A + B decreased from 21.0 to 8.8 (-58%), CRST C from 7.3 to 1.9 (-74.2%), and QUEST from 30.5 to 9.5 (-68.7%). Head and voice tremor were reduced by 73.8% and 40.3%, respectively. AEs were predominantly mild (95.2%) and transient (88%). Cognition at 1 year was globally preserved, with a selective decline in verbal episodic memory. Meta-analysis confirmed significant improvement in tremor severity. CONCLUSION: Staged bilateral MRgFUS thalamotomy was associated with sustained tremor reduction, including midline tremor, functional improvement and acceptability, with a manageable safety profile. Overall, consistent with literature, these findings support its potential role as a therapeutic option in selected ET patients.
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