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Evidence to Improve Care

Magnetic Resonance-Guided Focused Ultrasound Neurosurgery for Essential Tremor

Final Recommendation

  • Health Quality Ontario, under the guidance of the Ontario Health Technology Advisory Committee, recommends publicly funding magnetic resonance-guided focused ultrasound neurosurgery for people with moderate to severe, medication-refractory essential tremor

Read the Full Recommendation Report Here

Essential tremor is the most common type of movement disorder and most often affects the dominant hand. Essential tremor is estimated to affect up to 4 percent of Canadian adults, with an increase in severity and prevalence with age. As the tremor gets worse, it can negatively impact quality of life, limiting a person’s ability to perform daily activities such as eating, writing, walking, and self-care.

The first treatment available to manage essential tremor is medication, but about 50 percent of people do not respond well to medication or are unable to tolerate the side effects. The only other available treatment is neurosurgery (brain surgery), but the standard surgical treatments available are invasive procedures that involve opening the skull.

Magnetic resonance-guided focused ultrasound (MRgFUS) neurosurgery is a new, noninvasive surgical technology for the treatment of essential tremor. Since MRgFUS neurosurgery is noninvasive, it does not have the same surgical risks as invasive procedures.

Health Quality Ontario studied the effectiveness, safety, cost-effectiveness, and budget impact of publicly funding MRgFUS neurosurgery, as well as the preferences and values of people with essential tremor with regard to treatment options.

Our assessment showed that MRgFUS neurosurgery is generally safe and effective at reducing tremor severity, improving quality of life, and helping people get back to their daily activities. MRgFUS neurosurgery may be a treatment option for people with moderate to severe essential tremor for whom medication has not worked and who are unable to undergo invasive surgery or who are unwilling to accept the risks of invasive surgery.

People with essential tremor whom we interviewed who had undergone MRgFUS neurosurgery reported positive experiences with the procedure and felt that it had improved their quality of life by substantially reducing their tremors.

The cost-effectiveness analysis shows that for people with essential tremor who cannot undergo invasive neurosurgery, MRgFUS neurosurgery represents good value for money compared with no surgery. For people who can undergo invasive neurosurgery, MRgFUS neurosurgery is one of several reasonable options. The additional cost to the province to publicly fund MRgFUS neurosurgery at the current level of 48 cases per year would be about $1 million per year for the next 5 years.

Magnetic Resonance-Guided Focused Ultrasound Neurosurgery for Essential Tremor: A Health Technology Assessment May 2018

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The Ministry of Health has accepted this recommendation.

The Ministry of Health and Long-Term Care has provided the following response: The ministry currently funds magnetic resonance guided focused ultrasound neurosurgery for essential tremors. This treatment is currently offered at Sunnybrook Health Sciences Center and University Health Network (UHN).

Health Technology Assessment at Health Quality Ontario

As part of our core function to promote health care supported by the best available evidence, we use established scientific methods to analyze the evidence for a wide range of health interventions, including diagnostic tests, medical devices, interventional and surgical procedures, health care programs and models of care. These analyses are informed by input from a range of individuals, including patients and clinical experts. The Ontario Health Technology Advisory Committee — a committee of the Health Quality Ontario board of directors — reviews the evidence and makes recommendations about whether health care interventions should be publicly funded or not. Draft recommendations are posted on the Health Quality Ontario website for feedback. Final recommendations are approved by our board of directors and then shared with the Ministry of Health and Long-Term Care. For more detailed information, visit our Evidence to Improve Care pages.


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