Impact of Unilateral Magnetic Resonance-Guided Focused Ultrasound Thalamotomy in Quality of Life, Nonmotor Symptoms, and Patient-Reported Outcomes in Essential Tremor.

Abstract

Refractory tremor affects quality of life in patients with essential tremor (ET), often accompanied by nonmotor symptoms (NMS) that further impair daily functioning and well-being. This study aimed to evaluate the effects of magnetic resonance-guided focused ultrasound (MRgFUS) unilateral thalamotomy on quality of life and NMS in patients with refractory ET. We conducted a prospective observational study including patients treated with unilateral MRgFUS thalamotomy between February 2022 and March 2025. Evaluations were performed at baseline, Day 7, and 3, 6, and 12 months post-treatment. Tremor severity was assessed using the Clinical Rating Scale for Tremor. Quality of life was measured using the Quality of Life in Essential Tremor Questionnaire and the EuroQol-5-Dimension-5-Level Questionnaire. Depression and anxiety were evaluated via the Geriatric Depression Scale (15-item) and Geriatric Anxiety Inventory. Patient perception was assessed using the Patient Global Impression of Severity and Improvement scales. A total of 187 patients were included; 116 (62.03%) completed 12-month follow-up. Treated side-Clinical Rating Scale for Tremor scores decreased from 17.96 ± 4.55 to 3.77 ± 4.38 at 12 months (P < .001). Quality of life scores (Quality of Life in ET Questionnaire, EuroQol-5-Dimension-5-Level questionnaire) improved significantly at all follow-up (P < .05). Geriatric Depression Scale (15-item) and Geriatric Anxiety Inventory scores were significantly reduced at 6 and 12 months (P < .01). At 12 months, 89.7% of patients described improvement, and 45.22% of patients reported mild tremor at most. Unilateral MRgFUS thalamotomy leads to significant, sustained improvements in quality of life and NMS in patients with refractory ET with most patients reporting a marked clinical benefit at 1 year.