Objective: To quantify the tremor control and life quality changes of refractory essential tremor (ET) patients after the MR-guided focused ultrasound (MRgFUS) thalamotomy in Taiwan.

Background: There were more than 1 million people suffered from ET by estimation, and near more than 60% of ET patients were refractory to medication. The uncontrollable tremor from the bilateral hands, legs, head, truck, or even vocal cord impacted the daily regulation of patients and further affected to the social interaction. Recently review suggested that MRgFUS thalamotomy has more benefits than to other surgical approaches to mitigate ET. Here we reported the first quantitative analysis on the tremor control and life quality improvements of refractory ET patients after the MRgFUS thalamotomy in Taiwan.

Methods: Ten patients (two females, 52.3±11.6 years old, one left handiness) with informed consents were recruited in this study. Different medication and dosages were given during a one-month screening period. Brain MRI, Tc99m-ECD SPECT, CT, laboratory exam, and behavioral movement test were arranged to excluded the other movement disorders. CDR, CASI, MMSE, MoCA, and NPI and recorded to estimation the psychological conditions. The scores of Clinical Rating Scale for Tremor (CRST) and Quality of Life in Essential Tremor Questionnaire (QUEST) were recorded to quantify the tremor control and life quality before and one-month after the MRgFUS thalamotomy respectively. Single-tailed pair t test was exam to CRSTs and QUESTs indices before and one-month after the MRgFUS thalamotomy.

Results: These ten patients showed refractory to different combination of medication and dosages. Brain MRI, Tc99m-ECD SPECT, CT, laboratory exam, and behavioral movement test suggested that these ten patients were ET people. CDR (0.25±0.42), CASI (52.3±11.6), MMSE (52.3±11.6), MoCA (52.3±11.6), and NPI (52.3±11.6) revealed normal psychological conditions. CRST and QUEST before and one-month after the MRgFUS thalamotomy were 36.0±10.2 vs. 14.2±4.8 (p<10-5) and 65.8±26.0 vs. 44.5±22.6 (p<10-4), respectively.

Conclusions: Our results suggested that MRgFUS thalamotomy could significantly improve the tremor control and life quality of refractory ET patients in Taiwan. MRgFUS could not only mitigate ET but also the other types of tremor such as Parkinson disease. MRgFUS become a promising tool to improve tremor control and life quality of variety of movement disorders in Taiwan.

References: 1. Louis, E. D., Ford, B., Lee, H., Andrews, H. & Cameron, G. Diagnostic criteria for essential tremor: a population perspective. Arch. Neurol. 55, 823–8 (1998). 2. Hariz, G.-M., Bergenheim, A. T., Hariz, M. I. & Lindberg, M. Assessment of ability/disability in patients treated with chronic thalamic stimulation for tremor. Mov. Disord. 13, 78–83 (1998). 3. Rohani, M. & Fasano, A. Focused Ultrasound for Essential Tremor: Review of the Evidence and Discussion of Current Hurdles. Tremor Other Hyperkinet. Mov. (N. Y). 7, 462 (2017).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improvements-of-tremor-control-and-life-quality-of-refractory-essential-tremor-patients-after-mr-guided-focused-ultrasound-thalamotomy-a-taiwan-experience/