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

BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.