A TRIAL OF FOCUSED ULTRASOUND THALAMOTOMY VERSUS DEEP BRAIN STIMULATION FOR MEDICATION-REFRACTORY ESSENTIAL TREMOR: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Essential tremor (ET) is the most common movement disorder, often refractory to medical therapy, leading to significant disability and reduced quality of life. Deep brain stimulation (DBS) has long been the surgical gold standard, while magnetic resonance–guided focused ultrasound (MRgFUS) thalamotomy has emerged as a noninvasive alternative. Comparative data from randomized controlled settings remain limited, particularly regarding long-term outcomes in developing regions.

Objective: To compare the long-term efficacy, adverse event profiles, and quality of life improvements between MRgFUS thalamotomy and DBS in patients with medication-refractory essential tremor.

Methods: This randomized controlled trial was conducted at a tertiary care hospital in Lahore, enrolling 60 patients with medication-refractory ET, randomly assigned to MRgFUS or DBS. Primary outcomes included changes in tremor severity measured by the Clinical Rating Scale for Tremor (CRST), while secondary outcomes assessed quality of life using the Quality of Life in Essential Tremor Questionnaire (QUEST) and incidence of adverse events. Patients were evaluated at baseline, and at 3-, 6-, and 12-months post-intervention. Statistical analysis was performed using independent and paired t-tests and repeated-measures ANOVA (p < 0.05).

Results: Both groups showed significant improvement in tremor control and quality of life at all follow-up points. At 12 months, mean CRST scores improved by 53% in the MRgFUS group and 61% in the DBS group (p = 0.028). QUEST scores improved by 36% and 41%, respectively (p = 0.020). Adverse events were fewer with MRgFUS, which had transient sensory and balance disturbances, whereas DBS was associated with hardware-related complications.

Conclusion: Both MRgFUS and DBS are effective for medication-refractory ET. DBS demonstrated slightly superior long-term tremor suppression, while MRgFUS offered comparable efficacy with a safer, less invasive profile, supporting its role as a viable alternative for select patients.