Do you consider DBS for Essential Tremor in patients who already underwent Focused Ultrasound Thalamotomy?

In patients with medication-refractory essential tremor, ablative thalamotomy (with focused ultrasound stereotactic surgery, or gamma knife) and deep brain stimulation (DBS) are effective methods for the management of tremor. Ablative thalamotomy with focused ultrasound uses acoustic energy for remote lesioning of the target region (VIM nucleus). Failure to achieve the optimal response could occur due to a number of factors, including technical problems due to anatomical variations such as skull...

I agree with Dr. @Dr. First Last. Patient decisions need to be individualized. And if the DBS target is already ablated by FUS, then considering alternative locations of lead placement, like subthalamic zone/zona incerta, could be considered with neurosurgical planning discussion. This is off-label, of course. Performing FUS after suboptimal DBS has also been reported.

This is an area ripe for further research.