Magnetic resonance-guided focused ultrasound for the management of tremor: update on the position statement of the American Society for Stereotactic and Functional Neurosurgery

Authors

• Clement Hamani
• W Jeffrey Elias
• Gordon H Baltuch
• Robert E Gross
• Joshua M Rosenow
• Jason M Schwalb
• Ellen L. Air, Henry Ford HealthFollow
• Andre G Machado
• Jennifer Sweet
• Jon T Willie
• John D Rolston
• Dario J Englot
• Nir Lipsman
• Ajmal Zemmar
• Joseph S Neimat
• G Rees Cosgrove
• Wael F Asaad
• Rushna Ali
• Julie G Pilitsis
• Shabbar F Danish

Recommended Citation

Hamani C, Elias WJ, Baltuch GH, Gross RE, Rosenow JM, Schwalb JM, Air EL, Machado AG, Sweet J, Willie JT, Rolston JD, Englot DJ, Lipsman N, Zemmar A, Neimat JS, Cosgrove GR, Asaad WF, Ali R, Pilitsis JG, Danish SF. Magnetic resonance-guided focused ultrasound for the management of tremor: update on the position statement of the American Society for Stereotactic and Functional Neurosurgery. J Neurosurg. 2026;1-9.

Document Type

Article

Publication Date

3-27-2026

Publication Title

Journal of neurosurgery

Keywords

Parkinson’s disease; deep brain stimulation; essential tremor; focused ultrasound; functional neurosurgery; thalamotomy

Abstract

OBJECTIVE: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has become a popular tool in the neurosurgical armamentarium for managing tremor in patients with essential tremor (ET) and Parkinson's disease (PD).

METHODS: Given the recent exponential growth in the use of this technology, the American Society for Stereotactic and Functional Neurosurgery, which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides an update on treatment indications and the efficacy and safety of MRgFUS for the treatment of tremor.

RESULTS: In ET, the efficacy of MRgFUS thalamotomy is supported by several open-label and 1 prospective, double-blind, sham-controlled randomized clinical trial (RCT) that showed a 47% improvement in hand tremor in the short term. Follow-up studies demonstrated that the benefits of MRgFUS for ET are sustained in the long term. Studies investigating the effects of bilateral staged MRgFUS thalamotomy in patients with ET have shown that tremor improvement on the second side was as significant as that observed after the first procedure. The efficacy of MRgFUS thalamotomy for PD tremor is supported by a systematic meta-analysis that consisted predominantly of smaller, nonrandomized studies; 1 RCT; and 1 prospective cohort study. Despite a significant short-term improvement in PD tremor, the long-term effects of this therapy remain unknown. Common early adverse effects of MRgFUS thalamotomy include gait disturbance and paresthesias. These, however, tend to subside over time. Other reported side effects are dysarthria, ataxia, taste disturbance, motor deficits, and speech difficulty.

CONCLUSIONS: MRgFUS thalamotomy is a safe, effective, and durable intervention for refractory ET in appropriately selected patients. The procedure appears to be safe and effective for PD tremor, although the long-term durability of the technique remains a concern. Early experience with bilateral staged lesions for ET suggests the procedure to be safe and effective.

PubMed ID

41894813

ePublication

ePub ahead of print

First Page

1

Last Page

9