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Essential Tremor – MRgFUS Thalamotomy — SCE Neurology MCQ

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HardMovement DisordersEssential Tremor – MRgFUS ThalamotomySCE Neurology

A patient with severe bilateral essential tremor wants a procedure that can be adjusted over time and can treat both sides. Which comparison should guide the MDT discussion?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Bilateral adjustable DBS versus a permanent unilateral MRgFUS lesion

Explanation lettering: E = shown as A · A = shown as C · C = shown as D · D = shown as E

E is correct. DBS uses implanted, programmable stimulation and can be bilateral; MRgFUS thalamotomy makes a permanent unilateral lesion. NICE highlights uncertainty about bilateral functional impact and requires special governance, audit and MDT selection. The lesion cannot be retuned later, bilateral MRgFUS is not routine NICE care, and medication failure is the context for considering rather than prohibiting procedures.

Reference: NICE HTG474 unilateral MR-guided focused-ultrasound thalamotomy: https://www.nice.org.uk/guidance/htg474/chapter/1-Recommendations