This systematic review evaluates whether transcranial magnetic resonance-guided high-intensity focused ultrasound treatment (tcMRgFUS) is more effective and safe compared to sham, deep brain stimulation or radiofrequency thalamotomy in patients with drug-resistant essential tremor (ET).

One RCT and two retrospective comparative cohort studies were identified. Furthermore, two prospective single-arm observational studies were included for safety outcomes. TcMRgFUS is superior to sham procedure in terms of tremor severity, functional disability, and health-related quality of life at the 3-month follow-up period in patients who are not eligible or not yet eligible for deep brain stimulation.

Safety data indicate that tcMRgFUS may be a safe treatment option for this patient population. For patients eligible for deep brain stimulation, the evidence is insufficient to assess comparative efficacy and safety due to the critical risk of bias and retrospective design. Randomised, comparative studies are needed, focusing on directive comparing tcMRgFUS in patients eligible for deep brain stimulation and long-term safety in large registry-based studies.