Objective: To describe the effect of VIM thalamotomy by MRI-guided Focused Ultrasound (MRIgFUS) on Multiple Sclerosis (MS) tremor in a single patient.

Background: Tremor is the most frequently described movement disorder in MS (from 25% to 58%¹ depending on the series) and can be medically refractory and highly disabling. Both thalamic deep brain stimulation and radiofrequency thalamotomy have shown to provide sustained benefit in selected patients². The recent development of MRIgFUS allows performing ablations in deep brain structures through an incisionless approach, reducing the risks related to surgery. This could be of special importance in already damaged brains, such as those of MS patients.

Methods: A 28-year-old female diagnosed with MS was selected for MRIgFUS VIM thalamotomy to treat right upper limb tremor refractory to medical treatment and highly disabling. Assessment was performed both at baseline and 3 months after treatment through the Fahn-Tolosa-Marin scale (FTM scale), as well as with EMG and accelerometer recordings.

Results: Abolition of tremor was achieved intraprocedure after initial therapeutic sonications. The benefit was sustained by three months, with a 81.8% of improvement in the score of the FTM scale for the treated hand (FTM part A= 11 at baseline vs 2 at 3 months). Accelerometer and EMG tremor recording supported the clinical improvement. After treatment, the patient was able to use her hand normally. Mild-to-moderate dysarthria occurred after procedure, but it had practically resolved by 3 months.

Conclusions: This is, to our knowledge, the first report of a MS associated-tremor successfully treated with MRIgFUS thalamotomy. This poses a potentially new therapeutic option for MS patients suffering of tremor refractory to medical treatment.

References: ¹Pittock S, McClelland R, Mayr W, et al. Prevalence of tremor in multiple sclerosis and associated disability in the Olmsted County population. Mov Disor. 2004; 19:1482-1485. ²Schuurman PR, Bosch DA, Merkus MP, Speelman JD. Long-term follow-up of thalamic stimulation versus thalamotomy for tremor suppression. Mov Disord. 2008 Jun 15;23(8):1146-53.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/mri-guided-focused-ultrasound-thalamotomy-for-multiple-sclerosis-associated-tremor-a-case-report/