NICE issues positive guidance on use of MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor.- Insightec.

Insightec announced that The National Institute for Health and Care Excellence (NICE) issued a positive NICE guidance for unilateral MRI-guided focused ultrasound thalamotomy for treatment-resistant essential tremor (ET). NICE reported that 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.

NICE also recommends that doctors must 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 is recommended. It also says that 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.

To assess the evidence NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 11 sources, which was discussed by the committee. The evidence included 1 systematic review, 1 randomised controlled trial (2 publications providing 1- and 2?year follow-up data), 2 non-randomised comparative studies and 6 case series.