Magnetic Resonance-Guided Focused Ultrasound Neurosurgery for Essential Tremor: A Health Technology Assessment

Essential tremor is the most common movement disorder and most often affects the dominant hand and arm. As the tremor gets worse, it can negatively impact quality of life. Medication is the first treatment, but it does not work for many people. The next treatment option is neurosurgery (brain surgery). Presently in Ontario, the neurosurgery options generally available are invasive procedures that involve craniotomy (opening the skull). Magnetic resonance-guided focused ultrasound (MRgFUS) neurosurgery is a new, noninvasive surgical technology for the treatment of essential tremor. Because MRgFUS neurosurgery is noninvasive, it does not have the same surgical risks as invasive procedures. Thus, it may be an option for people who cannot undergo invasive surgery and for people who find the risks of invasive surgery, such as craniotomy, general anaesthetic, and implanted hardware, unacceptable. 

In this HTA the evidence to evaluate the effectiveness and safety of MRgFUS neurosurgery is reviewed, assessed the cost-effectiveness of MRgFUS neurosurgery compared with other surgical treatments, and calculated the budget impact of publicly funding MRgFUS neurosurgery. We also interviewed people with essential tremor to learn about their experiences and to gain an understanding of their preferences and values with regard to treatment options for essential tremor, including MRgFUS neurosurgery.