Objective: To relate efficacy and safety outcomes to patient satisfaction at 6 months after MR-guided focused ultrasound (MRgFUS) thalamotomy in the ventral intermediate nucleus (VIM) for tremor treatment.

Background: MRgFUS has many practical advantages but side effects are relatively common. Nonetheless, popularity among patients is high.

Method: We conducted a retrospective analysis of 52 patients with pharmaco-resistant tremor disorders (32 patients with Essential tremor (plus), 5 with dystonic tremor, 15 with Parkinson’s disease), who received first-in-life, unilateral MRgFUS thalamotomy in the VIM at the University Hospital Zurich, Switzerland, between 2017 and 2022 by one neurosurgeon. Standardized video-recorded assessments of efficacy (WHIGET tremor scale) and safety outcomes (standardized grading system based on impact on quality of life) at baseline and at 6 months post-treatment were reviewed. Overall patient satisfaction was evaluated by asking: “Based on what you know today, weighing tremor reduction and side effects, would you undergo the procedure again?“ (YES / NO).

Results: At 6 months, there was a significant average tremor reduction of 63% for the treated side, with 21 patients (40%) having an excellent (>75% tremor reduction), 17 (33%) having a good (50-75%), 6 (12%) having a moderate (25-49%) and 8 (15%) having a poor treatment response (<25%).

Persistent side effects were reported by 26 patients (50%), of whom 10 patients (19% of the total study population) described moderate severity. Gait impairment was present in 17 patients (33%, 25% mild, 8% moderate intensity), arm ataxia in 8 patients (15%, 2% mild, 13% moderate intensity) and sensory disturbance in 10 patients (19%, 17% mild, 2% moderate intensity). Other persistent side effects included dysarthria (n=3, 6%), dysgeusia (n=1, 2%) and dysphagia (n=1, 2%).

Nevertheless, 45 of 52 patients (87%), declared that they would undergo the procedure again, whereas 7 patients (13%) would decline. Of these 7 patients, 5 had poor tremor control (all with Parkinson’s disease) and only 2 had side effects which they valued higher than tremor improvement.

Conclusion: Most side effects, even when impacting on quality of life, seem to be well tolerated if tremor control is satisfactory.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/weighing-tremor-reduction-and-side-effects-impact-of-efficacy-and-safety-outcomes-on-patient-satisfaction-at-6-months-in-mr-guided-focused-ultrasound-thalamotomy-for-tremor-treatment/