NEJM Study Shows MRgFUS Thalamotomy Aids Treatment of Essential Tremor
August 25, 2016
Essential tremor is a common nervous system disorder that causes rhythmic shaking of the hands, legs, trunk, head and/or voice and can greatly reduce one’s quality of life. Simple tasks like tying shoelaces, writing, or eating and drinking are difficult to complete. In the US, it affects more than 200,000 people per year. Medications serve as first-line treatment for the condition, but medication resistance or side effects can limit effectiveness. For these patients, neurosurgical intervention is considered.
Pejman Ghanouni, MD, PhD, and Kim Butts Pauly, PhD, from the Department of Radiology, Casey Halpern, MD, from the Department of Neurosurgery, and Rosa Chuang, MD, from the Department of Neurology, are authors on an article published in the New England Journal of Medicine presenting the results of a clinical trial conducted at twelve international centers. This double-blind trial used magnetic resonance imaging guided focused ultrasound (MRgFUS) thalamotomy to non-invasively relieve the symptoms of essential tremor in the hand.
Three months after MRgFUS treatment, patients saw their hand tremor reduced by 47 per cent, their disability reduced by 62%, and their quality of life improved by 46%. That's compared to less than one per cent improvement in hand tremor, a 3% reduction in disability, and a 3% improvement in quality of life in those who received a so-called “sham” or placebo procedure. Importantly, the results were durable over the one year of follow up included in the study, with longer-term evaluation continuing. Side effects included sensory or gait disturbances.
Currently, deep brain stimulation (DBS) is the standard neurosurgical intervention available for patients who have tremor that is not controlled by medications; however, few patients with essential tremor opt for DBS because of the need for placing electrodes in the brain through burr holes in the skull. Based on this work, transcranial MR guided focused ultrasound thalamotomy was shown to be an effective, less invasive method for the treatment of essential tremor.