Real‐World Evaluation of Bilateral Magnetic Resonance–Guided Focused Ultrasound Thalamotomy in Essential Tremor

BACKGROUND: Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy is effective in treating essential tremor (ET) with an adequate safety profile. OBJECTIVE: The aim of the study was to evaluate the real-world safety and efficacy of staged bilateral MRgFUS thalamotomy in ET and its impact on patient's quality of life (QoL) and patient-reported outcomes (PROs). METHODS: This prospective cohort study included patients with ET who underwent staged bilateral thalamotomy. The primary endpoint was the change in the total Clinical Rating Scale for Tremor (CRST) score from baseline (prior to the first thalamotomy) to after the second treatment. Secondary endpoints included CRST subscales, QoL scales assessed using QoL in ET questionnaire (QUEST), EuroQol-5 Dimension-5-level questionnaire (EQ-5D-5L), and patient-reported outcomes (PROs). Adverse events (AEs) were documented. RESULTS: Fifty-five patients were included. The CRST total score improved 66.6% from baseline to 6 months after staged bilateral thalamotomy. QUEST score improved by 35.3 points. After the second treatment, 60% of patients reported having at most a mild tremor and 69.2% considered that their tremor was "much improved" or "very much improved." Six-months after staged bilateral thalamotomy, 15 (45,4%) patients had at least one adverse event, sensory disturbances being the most frequent (27.3%), followed by instability (12.1%) and dysarthria (12.1%). All AEs were mild, except in one case in which the patient showed moderate perioral paresthesia. CONCLUSIONS: Staged bilateral MRgFUS thalamotomy provides significant improvement in tremor severity, functional outcomes, and QoL among patients with ET, although controlled studies should be conducted to confirm these results. The safety profile is adequate, although AEs are slightly higher than after the unilateral treatment. © 2026 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.