Cognitive outcomes following unilateral magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: findings from two cohorts

Julie Petersen; Josh McGough; Georgia Gopinath; Nadia Scantlebury; Richa Tripathi; Cheryl Brandmeir; Silina Z Boshmaf; Nicholas J Brandmeir; Isabella J Sewell; Peter E Konrad; Agessandro Abrahao; Ann Murray; Benjamin Lam; Manish Ranjan; Clement Hamani; Jessica Frey; Camryn Rohringer; Melissa McSweeney; James J Mahoney 3rd; Michael L Schwartz; Ali Rezai; Nir Lipsman; David M Scarisbrick; Jennifer S Rabin

doi:10.1093/braincomms/fcae293

Cognitive outcomes following unilateral magnetic resonance-guided focused ultrasound thalamotomy for essential tremor: findings from two cohorts

Brain Commun. 2024 Aug 30;6(5):fcae293. doi: 10.1093/braincomms/fcae293. eCollection 2024.

Authors

Julie Petersen^{1

2}, Josh McGough¹, Georgia Gopinath³, Nadia Scantlebury⁴, Richa Tripathi⁵, Cheryl Brandmeir¹, Silina Z Boshmaf³, Nicholas J Brandmeir^{6

7}, Isabella J Sewell³, Peter E Konrad^{6

7}, Agessandro Abrahao^{3

4

8}, Ann Murray⁹, Benjamin Lam^{3

8}, Manish Ranjan⁷, Clement Hamani^{3

4

10}, Jessica Frey⁹, Camryn Rohringer³, Melissa McSweeney³, James J Mahoney 3rd^{1

6

11}, Michael L Schwartz^{3

10}, Ali Rezai^{6

7}, Nir Lipsman^{3

4

10

12}, David M Scarisbrick^{6

11}, Jennifer S Rabin^{3

4

8

13}

Affiliations

¹ Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV 26505, USA.
² Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
³ Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada M4N 3M5.
⁴ Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada M4N 3M5.
⁵ Jean and Paul Amos PD and Movement Disorders Program, Department of Neurology, Emory University School of Medicine, Atlanta, GA 30307, USA.
⁶ Department of Neuroscience, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV 26505, USA.
⁷ Department of Neurosurgery, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV 26505, USA.
⁸ Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada M4N 3M5.
⁹ Department of Neurology, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV 26505, USA.
¹⁰ Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada M4N 3M5.
¹¹ Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Rockefeller Neuroscience Institute, Morgantown, WV 26505, USA.
¹² Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada M4N 3M5.
¹³ Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada M5G 1V7.

Abstract

Magnetic resonance-guided, focused ultrasound thalamotomy is a neurosurgical treatment for refractory essential tremor. This study examined cognitive outcomes following unilateral magnetic resonance-guided, focused ultrasound thalamotomy, targeting the ventral intermediate nucleus of the thalamus for essential tremor. The research was conducted at two sites: Sunnybrook Research Institute in Toronto, Canada, and West Virginia University School of Medicine Rockefeller Neuroscience Institute in West Virginia, USA. The study focused on cognitive changes at both the group and individual levels. Patients with refractory essential tremor completed cognitive testing before and after magnetic resonance-guided, focused ultrasound thalamotomy at both sites. The cognitive testing assessed domains of attention, processing speed, working memory, executive function, language and learning/memory. Postoperative changes in cognition were examined using paired t-tests and Wilcoxon signed-rank tests, as appropriate. Reliable change indices were calculated to assess clinically significant changes at the individual level. A total of 33 patients from Toronto and 22 patients from West Virginia were included. Following magnetic resonance-guided, focused ultrasound thalamotomy, there was a significant reduction in tremor severity in both cohorts. At the group level, there were no significant declines in postoperative cognitive performance in either cohort. The reliable change analyses revealed some variability at the individual level, with most patients maintaining stable performance or showing improvement. Taken together, the results from these two independent cohorts demonstrate that unilateral magnetic resonance-guided, focused ultrasound thalamotomy significantly reduces tremor severity without negatively impacting cognition at both the group and individual levels, highlighting the cognitive safety of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor.

Keywords: cognition; essential tremor; magnetic resonance–guided focused ultrasound; neuropsychology; thalamotomy.

Grants and funding

U54 GM104942/GM/NIGMS NIH HHS/United States