Hypnosis as a Non-Pharmacologic Adjunct in Magnetic Resonance-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Case Report

BACKGROUND Transcranial magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has become an established and effective therapeutic option for patients with essential tremor (ET) who do not adequately respond to medication. Although generally safe and minimally invasive, this procedure is lengthy and highly interactive; it requires patients to remain awake, cooperative, and motionless for several hours. Intraprocedural side effects (SEs) are relatively common. Reports frequently describe symptoms such as vertigo, scalp burning sensation, nausea, perioral paresthesia, headache, and reduced patient cooperation. Management of these issues usually relies on pharmacologic interventions, including anxiolytics or analgesics, which may interfere with patient responsiveness. Non-pharmacologic strategies have received far less attention. To date, the potential role of hypnosis, either before or during MRgFUS, has not been explored in this context, although it may reduce SEs and promote greater patient comfort. CASE REPORT We describe a 75-year-old woman with longstanding, medication-refractory ET who underwent MRgFUS thalamotomy targeting the ventral intermediate nucleus of the thalamus. Before the intervention, a standardized hypnosis protocol was implemented for both emotional and physical preparation. During frame fixation and pre-procedural stages, guided hypnosis was provided. Patient-directed self-hypnosis was performed during the sonication process. No sedatives or anxiolytics were administered. The patient tolerated the procedure exceptionally well, without complications, interruptions, or pharmacologic support required; she expressed strong satisfaction with the experience. CONCLUSIONS These observations suggest that hypnosis represents a safe, feasible, and effective non-pharmacologic adjunct to MRgFUS thalamotomy, with the potential to reduce intraprocedural SEs and enhance patient cooperation.