Damisah, Eyiyemisi C.

OBJECTIVE Essential tremor (ET) is common and disabling in older adults. Many patients aged ≥ 80 years are ineligible for deep brain stimulation due to medical comorbidities. Data on noninvasive alternatives, such as MR-guided high-intensity focused ultrasound (MRgHIFU), remain limited in this population. The aim of this study was to evaluate the safety and efficacy of unilateral MRgHIFU thalamotomy targeting the ventral intermediate nucleus (VIM) for the treatment of ET in patients ≥ 80 years of age. METHODS This retrospective multicenter cohort study included consecutive patients aged ≥ 80 years with medically refractory ET treated with unilateral MRgHIFU VIM thalamotomy between 2016 and 2023 at five academic neurosurgical centers. All patients met skull density ratio criteria and underwent standardized targeting. Clinical assessments were conducted at baseline, immediately posttreatment, and at the 3-month follow-up. The primary outcome was change in tremor severity assessed by using the Tremor Research Group Essential Tremor Rating Assessment Scale (TETRAS). Secondary outcomes included the Clinical Rating Scale for Tremor (CRST) score, Dynamic Gait Index score, patient-reported tremor relief, and adverse events. RESULTS One hundred twenty-nine patients (76 male, mean age 84 years) were included. At 3 months, the mean TETRAS score improved by 9.2 points (p < 0.001). CRST scores also showed significant improvement. The mean patient-reported tremor relief was 81%. Adverse events were mild and transient, with a 1.6% rate of nonsurgical adverse events. Subgroup analysis comparing patients 80–84 years versus those ≥ 85 years of age showed no significant differences in treatment response. Gait outcomes improved modestly but were not significant in the age ≥ 85 years group. CONCLUSIONS Unilateral MRgHIFU thalamotomy is a safe and effective noninvasive treatment for ET in patients ≥ 80 years of age. It results in significant improvements in tremor and disability, with a low complication rate. These findings support its consideration for older patients who are ineligible for invasive procedures and highlight the importance of age-specific metrics in neuromodulation outcomes research.

Abstract Objective There is a need to develop a comprehensive, formalized, and globally applicable epilepsy surgery curriculum in order to help standardize the quality of epilepsy surgery practice in the world. Methods The Epilepsy Surgery Educational Task Force of the ILAE developed a competency‐based epilepsy surgery educational curriculum comprised of four domains: Diagnosis, Counseling, Pre‐surgical Work‐up, and Surgical Techniques. To evaluate this educational curriculum, a survey questionnaire consisting of 11 items was sent out for feedback to ILAE and IESS members. The survey questionnaire asked respondents to rate the degree of importance of each competency on a five‐point scale that ranged from “extremely important” to “not at all important” and provided space for free text comments. All competencies that were rated as “slightly important” or “somewhat important” by more than 10% of responders, as well as all free text feedback comments, were fully reviewed, and the final curriculum was adjusted accordingly. Results One hundred and twenty‐two responses ( n = 122) were submitted by the ILAE and IESS communities. Seventy‐one percent (71.9%) of the responses came from neurosurgeons of varied experience and training levels. Ninety‐four percent (94.4%) of responders stated that they “support a curriculum to determine the competency of neurosurgeons participating in the care of people with epilepsy in my country,” and 94.3% confirmed that they “would be interested in taking or would recommend an ILAE course based on these competencies, that would provide an ILAE certificate of completion.” Relevant changes within the curriculum were made based on feedback. Significance The newly developed ILAE comprehensive epilepsy surgery educational curriculum has a high level of support from neurosurgeons and neurologists around the world and shows potential for broad acceptance and implementation.

Abstract Up to 80% of the world's population with epilepsy lives in low and middle‐income countries. Around one‐third of these patients will have drug‐resistant epilepsy, for which epilepsy surgery is an option. Unfortunately, many of these regions, as well as some more developed nations, lack sufficient epilepsy surgery units and trained neurosurgeons. With this in mind, the International League Against Epilepsy (ILAE) formed the Epilepsy Surgery Education Taskforce to address the shortage of further educational opportunities for surgeons and neurologists and to promote the creation of more epilepsy surgery units around the world. In this article, we publish our findings from a web‐based international survey, in which we investigated the global distribution and experience of neurosurgeons who perform epilepsy surgery, their educational paths, and opinions on the further need for epilepsy surgery education, as well as the resources available to them. We report a detailed analysis of the 202 survey replies received from 35 different countries across six continents. The lack of adequate numbers of epilepsy surgery units in the Southern Hemisphere is notable, and the aim of this task force with other ILAE committees, is to improve access to epilepsy surgery for patients and to enhance training for their health care providers.