Magnetic Resonance-Guided Focused Ultrasound Thalamotomy to Treat Essential Tremor in Nonagenarians.

Authors: Paff M, Boutet A, Neudorfer C, Elias GJB, Germann J, Loh A, Kucharczyk W, Fasano A, Schwartz ML, Lozano AM

Essential tremor (ET) is a disabling movement disorder that is most prevalent among the elderly. While deep brain stimulation surgery targeting the ventral intermediate nucleus of the thalamus is commonly used to treat ET, the most elderly patients or those with multiple medical comorbidities may not qualify as surgical candidates. Magnetic resonance-guided focused ultrasound (MRgFUS) constitutes a less invasive modality that may be used to perform thalamotomy without the need for a burr hole craniotomy. Here, we report on 2 patients over the age of 90 years who benefited significantly from MRgFUS thalamotomy to relieve their symptoms and improve their quality of life. The procedure was well tolerated and performed safely in both patients. We conclude that age should not be a limiting factor in the treatment of patients with MRgFUS.

Introduction

Purpose Thermal ablation

Study Objective To report the safety and efficacy of MR-guided focused ultrasound thalamotomy for treating essential tremor in two patients over 90 years old.

Animal model / Human subject Human (Homo sapiens), strain: N/A, age: >90 years (two patients), sex: not reported

Disease model Essential tremor

MRI or image guidance method Magnetic resonance-guided (MRgFUS)

Targeted brain region(s) Thalamus

Outcomes and Safety

Summary of Outcomes MRgFUS thalamotomy produced substantial reduction of essential tremor and improved quality of life in two patients over 90 years, with the procedure being well tolerated and safe.

Safety-related matter The MRgFUS thalamotomy was well tolerated and performed safely in both patients; no adverse effects were reported.

Brain Region

Ultrasound Parameters

Focal Characteristics Focal depth: None; Focal length: None; Aperture size: None

Treatment frequency single session

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