1 Recommendations

Guidance

1.1 The evidence on the safety of unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor raises no major safety concerns. However, current evidence on its efficacy is limited in quantity. Therefore, this procedure should not be used unless there are special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.

1.2 Clinicians wishing to do unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor should:

Inform the clinical governance leads in their NHS trusts.
Ensure that patients and their carers understand that this procedure is only done to treat tremor on 1 side of the body, and that the effect of this on the functional ability and quality of life of patients with bilateral disease is uncertain. Patients should be informed about alternative treatments, including those that can be done bilaterally. Provide patients with clear written information to support shared decision-making. In addition, the use of NICE's information for the public on unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor is recommended.
Audit and review clinical outcomes of all patients having unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor. NICE has identified relevant audit criteria and has developed NICE's interventional procedure outcomes audit tool (which is for use at local discretion).

1.3 Patient selection should be done by a multidisciplinary team experienced in managing essential tremor, including clinicians with specific training in the procedure.

1.4 Further research, which could include randomised controlled trials, should address patient selection, report on functional improvement and quality of life, and provide long-term follow-up data.