Recordings from the 2025 Neuro-APP Symposium-To Zap Or Not To Zap

Video Transcription

Video Summary

Rachel Stouffer’s presentation reviewed high-intensity focused ultrasound (HIFU) for medication-refractory essential tremor. Essential tremor typically causes gradual, rhythmic action tremor, often affecting both hands and daily activities. Before considering a procedure, patients should receive an appropriate trial of at least two medications, such as propranolol, primidone, topiramate, or gabapentin.<br /><br />Candidates undergo multidisciplinary evaluation to confirm the diagnosis, assess surgical risks and cognition, and discuss realistic expectations. HIFU uses MRI-guided ultrasound to create a lesion in the thalamic ventral intermediate nucleus. It is incisionless and can provide rapid tremor improvement, but is not a cure and can cause balance, speech, swallowing, or sensory problems; some effects may persist. Careful patient selection and follow-up are essential. Bilateral treatment is now possible, generally at least nine months apart, but carries greater risk of side effects. The presentation emphasized documenting medication trials to help streamline referrals.

Keywords

high-intensity focused ultrasound

essential tremor

medication-refractory

MRI-guided ultrasound

thalamic ventral intermediate nucleus

bilateral treatment