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World Neurosurg. 2019 Feb 19. pii: S1878-8750(19)30400-0. doi: 10.1016/j.wneu.2019.01.281. [Epub ahead of print]

Unilateral Thalamic Deep Brain Stimulation vs. Focused Ultrasound Thalamotomy for Essential Tremor.

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Departments of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Departments of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.



The predominant neurosurgical approach to medication-refractory essential tremor (ET) is thalamic deep brain stimulation (DBS). The emergence of magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has reawakened the debate surrounding the use of DBS vs. thalamotomy for this indication. Herein we aimed to provide a contemporary comparison between DBS and MRgFUS.


Two controlled trials that evaluated DBS and MRgFUS for the unilateral treatment of refractory ET were compared. Clinical outcomes extracted included postural tremor score in the treated upper extremity, quality of life (QoL) and incidence of adverse events (AE).


Baseline patient characteristics were comparable in the two studies, except that DBS patients were younger and had more severe baseline tremor. Both DBS- and MRgFUS-treated patients had significant tremor improvement which was sustained for 1-year post-treatment, and significant improvement in QoL. The MRgFUS cohort had higher rates of persistent neurologic AE, while the DBS group had higher rates of surgery- and hardware-related AEs, including intracranial hemorrhage.


In context of prior literature, both DBS and MRgFUS significantly improve tremor control and QoL. The two approaches are predominantly differentiated by their AE-profile. Additional head-to-head comparison on matched clinical populations is required to more accurately compare clinical efficacy and long-term outcomes.


deep brain stimulation; essential tremor; focused ultrasound; thalamotomy; ventral intermedius nucleus


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