Objective: To report on the efficacy and safety of MRI-guided focused ultrasound (FUS) VIM-thalamotomy in patients with multiple system atrophy (MSA).

Background: FUS has established efficacy in tremor relief but its efficacy and safety in in relieving tremor in MSA patients has not been reported.

Method: Tremor was assessed overall and in the treated hemi-body using the Clinical Rating Scale for Tremor (CRST).

Results: Five Patients with possible MSA-Parkinsonian type with a median age of 69 years (range 67-74), median disease duration of 2 years range (1-7), were treated. FUS treatment resulted in immediate complete cessation of tremor at the end of the procedure in the treated arm in 4 patients and 69% improvement in 1 patient. At 1 month 3 patients remained tremor free, 1 patient had 28% improvement and in 1 patient tremor returned to baseline. After 1 year, 2 patients remained tremor free and another maintained 71% improvement. Adverse events included transient objective and subjective gait ataxia, lip paresthesias and asthenia that resolved within 1-12 months

Conclusion: Our report suggests that FUS VIM-thalamotomy may be effective in tremor relief in patients with MSA-P. Larger double blind studies are needed to verify our observations.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/focused-ultrasound-offers-tremor-relief-in-multiple-system-atrophy-patients/