Functional tremor developing after successful MRI-guided focused ultrasound thalamotomy for essential tremor.
Authors: Alshimemeri S, Vargas-Méndez D, Chen R, Lipsman N, Schwartz ML, Lozano AM, Fasano A
To describe a case of functional tremor occurring after a successful MR-guided focused ultrasound thalamotomy (MRgFUS) for essential tremor. A 71-year-old right-handed man with essential tremor was referred to us for consideration of deep brain stimulation surgery for worsening bilateral upper limb tremor after a successful left MRgFUS for essential tremor. On clinical exam, signs compatible with a functional tremor were noted, including entertainability and suppressibility. Electrophysiological studies were consistent with essential tremor and superimposed tremor fulfilling the laboratory-supported criteria for functional tremor. We describe the first reported case of a functional movement disorder occurring after successful MRgFUS procedure for essential tremor. Recognising this entity and its development after such therapeutic interventions is essential to avoid further unnecessary invasive therapies.
Introduction
Purpose
Other
Study Objective
To report and characterize the development of functional tremor following successful MRI-guided focused ultrasound thalamotomy for essential tremor.
Animal model / Human subject
Human (Homo sapiens), strain: N/A, age: not reported, sex: not reported
Disease model
Essential tremor (with subsequent development of functional tremor after MRI-guided focused ultrasound thalamotomy)
MRI or image guidance method
MRI-guided focused ultrasound
Targeted brain region(s)
Thalamus
Cargo name and characteristics
MRI-guided focused ultrasound thalamotomy (MRgFUS) — a noninvasive, image-guided high-intensity focused ultrasound thermal ablation procedure targeting the thalamic ventral intermediate nucleus for treatment of essential tremor
Route of administration
Not specified in the provided text
Outcomes and Safety
Summary of Outcomes
A functional (psychogenic) tremor emerged after successful MRI-guided focused ultrasound thalamotomy performed to treat essential tremor.
Duration of biological effect
Not reported
Safety-related matter
A functional tremor developed as an adverse outcome following an otherwise successful MRI-guided focused ultrasound thalamotomy for essential tremor.
Brain Region
Ultrasound Parameters
Ultrasound instrument
Not specified
FUS Frequency
Not reported in provided text
FUS Intensity
Not reported in provided text
FUS Pressure
Not reported
FUS Mode
pulsed
Pulse duration
not reported
Duration of a single FUS session
Not reported in the provided text
Focal Characteristics
Not reported
Treatment frequency
single session
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