Key Points
- In September 2023, the Foundation and Insightec hosted a workshop on brain targeting during focused ultrasound ablation of essential tremor.
- The presentations, discussions, and action items have now been summarized in a white paper.
In September 2023, the Foundation hosted a workshop on brain targeting during focused ultrasound ablation of essential tremor (ET). The goal of the workshop was to assess targeting techniques used across multiple active sites treating ET and work toward optimizing and standardizing the targeting approach. The one-and-a-half-day event was co-sponsored by Insightec.
The workshop’s presentations and discussion have now been summarized in a white paper.
More than 30 subject matter experts in attendance discussed six burning questions:
- What is the best target for focused ultrasound ablation for ET?
- How is the “best” target determined, and how can we standardize localization into a method?
- How does the clinician know when to stop – when is the treatment finished?
- Once determined and standardized, what percentage reduction of side effects could be realized?
- Once determined and standardized, what percentage increase in efficacy could be realized?
- What outcome measures should be standard practice in assessing the thermal lesion?
In addition to these questions, presentations addressed the current state of the field, reviewed various targeting methods in use today, and highlighted companies specializing in brain targeting.
While there was no consensus about the best target and how to standardize localization, various approaches for optimal targeting included atlas-based targeting, direct targeting with white matter–nulling MRI sequences, diffusion tensor imaging tractography, connectomics, and neuromodulation.
Participants highlighted the importance of collaborative efforts to analyze and compare retrospective data across centers using different targeting methods. Standardizing imaging protocols, clinical outcomes, timing of assessments, and safety/efficacy metrics will be important to enable this collaborative data analysis.
Overall, the workshop convened experts to engage in provocative discussions and debates to determine the optimal standardized approach to focused ultrasound thalamotomy for essential tremor through data sharing and analysis and creating a roadmap to move the field forward.