The Optimal Targeting for Focused Ultrasound Thalamotomy Differs between Dystonic and Essential Tremor: A 12-Month Prospective Pilot Study

Abstract

Background: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is increasingly used to treat drug-resistant essential tremor (ET). Data on MRgFUS thalamotomy in dystonic tremor (DT) are anecdotal.

Objectives: To investigate efficacy, safety, and differences in target coordinates of MRgFUS thalamotomy in DT versus ET.

Methods: Ten patients with DT and 35 with ET who consecutively underwent MRgFUS thalamotomy were followed for 12 months. Although in both groups the initial surgical planning coordinates corresponded to the ventralis intermediate (Vim), the final target could be modified intraoperatively based on clinical response.

Results: Tremor significantly improved in both groups. The thalamic lesion was significantly more anterior in DT than ET. Considering both ET and DT groups, the more anterior the lesion, the lower the odds ratio for adverse events.

Conclusions: MRgFUS thalamotomy is safe and effective in DT and ET. Compared to classical Vim coordinates used for ET, more anterior targeting should be considered for DT.

Keywords: MRgFUS; dystonia; dystonic tremor; essential tremor; thalamotomy.

FIG. 1

Graphical representation of the center of thalamic lesions in dystonic tremor (DT) and essential tremor (ET) patients. The position of the lesion is reported in two dimensions, with the coordinates X (latero‐lateral coordinate, ie, distance of the center of the lesion from midline) and Y (anteroposterior coordinate, expressed as a percentage of the length of anterior commissure‐posterior commissure [ACPC] from the posterior commissure). Filled symbols represent patients with one or more adverse events. Dotted and dashed lines represent the mean antero‐posterior position of the thalamic lesion in DT and ET, respectively. The mean anteroposterior position of the thalamic lesion is more anterior in DT compared to ET. Partially created with BioRender.com.