Evidence map›Paper›PMID 40318052›Full record

ArticleMovement disorders : official journal of the Movement Disorder Society2025

Bilateral Focused Ultrasound Thalamotomy for Essential Tremor: Clinical Outcomes Compared to Bilateral Deep Brain Stimulation and Probabilistic Lesion Mapping.

Can Sarica, Kazuaki Yamamoto, Christian Iorio-Morin, Jurgen Germann, Andrew Z Yang, Brendan Santyr, Michael Colditz, Artur Vetkas, Anton Fomenko, Benjamin Davidson and 15 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Movement disorders : official journal of the Movement Disorder Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Surgical Treatment of Tremor Syndromes: A Guide to the Clinician.Movement disorders clinical practice · 2026
    Review
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors.

Can SaricaDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Kazuaki YamamotoFunctional Neurosurgery Center, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan.
Christian Iorio-MorinDivision of Neurosurgery, Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada.ORCID https://orcid.org/0000-0003-2995-7255
Jurgen GermannKrembil Research Institute, University Health Network, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0003-0995-8226
Andrew Z YangDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Brendan SantyrDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0003-1782-4527
Michael ColditzSchool of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Artur VetkasDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0002-4487-432X
Anton FomenkoDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Benjamin DavidsonDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Franziska SchmidtDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Talyta GrippeEdmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0003-3126-8002
Nardin SamuelEdmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, and Division of Neurology, University of Toronto, Toronto, Ontario, Canada.
Ajmal ZemmarDepartment of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Oliver FloutyDepartment of Neurosurgery and Brain Repair, Tampa Neurophysiology Laboratory, University of South Florida, Tampa, Florida, USA.
Cletus CheyuoDepartment of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
Ghazaleh DarmaniKrembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Robert ChenKrembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Alexandre BoutetJoint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
Clemens NeudorferDepartment of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Mojgan HodaieDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Suneil K KaliaDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Renato P MunhozKrembil Research Institute, University Health Network, Toronto, Ontario, Canada.
Alfonso FasanoKrembil Research Institute, University Health Network, Toronto, Ontario, Canada.ORCID https://orcid.org/0000-0001-5346-0180
Andres M LozanoDivision of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Funding

Alan & Susan Hudson Cornerstone Chair in Neurosurgery at University Health Network
6 · The paper itself

Abstract

backgroundThe efficacy and adverse events (AEs) of bilateral magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomies for essential tremor (ET) have not been compared to those of deep brain stimulation (DBS). Furthermore, it is uncertain whether second-side thalamotomies can be positioned differently from the first without compromising effectiveness.

objectiveWe aimed to indirectly compare bilateral MRgFUS and DBS, while identifying optimal lesion/stimulation locations.

methodsWe retrospectively examined 41 ET patients who received either bilateral thalamic DBS (n = 22) or MRgFUS (n = 19) surgery. The primary outcome was the comparison of modalities for change in Clinical Rating Scale for Tremor (CRST) from baseline to post second surgery. We characterized AEs, generated probabilistic maps, and tracked streamlines intersecting lesions. First-side lesions were always intentionally placed ventrally (z = 0/+2 mm above the intercommissural plane [ICP]), and second-side lesions were placed dorsally (z = +3 mm above ICP).

resultsTremor scores improved significantly after second surgeries (MRgFUS: 56.3 ± 7.1 to 24.2 ± 10.4, P < 0.001; DBS: 58.8 ± 11.6 to 25.0 ± 13, P < 0.05, mean follow-up: 23/26 months), with no differences between modalities. Following first surgeries, scores were MRgFUS: 37.9 ± 7.9 and DBS: 35.2 ± 13.6, with significant improvement from baseline (P < 0.001, mean follow-up: 40/73 months). All AEs were grade 1-2, with AE-free rates of 41% for DBS and 32% for MRgFUS. First-side lesions exhibited maximal efficacy in the ventral Vim, extending to posterior subthalamic area (PSA), whereas second-side lesions demonstrated maximal efficacy in the dorsomedial Vim-Vop border. DBS maps corroborated this finding and confined to Vim-Vop border. Lesions intersecting with networks interconnected with the supplementary motor area, in addition to M1, were associated with improved outcomes.

conclusionsThe efficacies of bilateral MRgFUS and DBS appear comparable. MRgFUS probabilistic maps vary with different targeting methods, revealing two distinct sweet spots: dorsal Vim-Vop border and ventral Vim/PSA. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Indexed as

Deep Brain StimulationEssential TremorThalamusAgedFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedRetrospective StudiesTreatment Outcomebilateral surgerydeep brain stimulationfiber filteringfocused ultrasoundprobabilistic mapping

Identifiers

PMID40318052
PMCPMC12273620

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.