MR-Guided Ultrasound for Essential Tremor & Parkinson's Disease
For inquiries about focused ultrasound treatment, please fill out our information request form.
MR-guided focused ultrasound is a non-invasive procedure that treats hand tremor in patients diagnosed with essential tremor and parkinson's disease. Our specialists use high-intensity focused ultrasound energy, guided by magnetic resonance imaging (MRI), to burn (ablate) a small targeted area of tissue in the brain. This procedure reduces hand tremor symptoms.
The Procedure
This procedure is done while the patient is awake. The MRI allows the physician to precisely plan, guide, and target a small, specific area of your brain. The MRI also precisely measures the increased temperature in the brain caused by the ultrasound energy. This allows it to precisely treat only the intended target.
This is an ideal treatment tool because ultrasound energy can pass through skin, muscle, fat, and bone without incisions (cuts). Ultrasound energy is also non-ionizing, meaning that you are not exposed to potentially dangerous radiation during the procedure.
Before Treatment
You will meet with one of our care team nurses to prepare you for the procedure. Your nurse will take your vital signs and fully shave your head (as required) for surgery. They will also place an IV tube (in your vein or intravenously) in your arm to give you any needed medications and a urinary cathether in your bladder, so you won’t have to go to the bathroom during the procedure.
You will be given numbing medication before a frame is placed on your head by your neurosurgeon. This head frame attaches to the MRI table to prevent any movement during the procedure. A silicon membrane is then placed on the head to allow for circulation of cool water. This will minimize potential heating near the scalp.
Your heart rate, blood pressure, and blood oxygen levels will be monitored throughout the procedure.
Planning the Treatment
Next, you will lie on the bed that will move you in and out of the MRI device. You will be conscious throughout the procedure so you can communicate with the physicians and nurses, and your specialists will perform the procedure from a computer in the room next to the MRI suite. They will be able to monitor you with a camera while a nurse monitors your vital signs to ensure you are doing well.
To plan the procedure, MRI images will be obtained so that your physician can locate the area to be treated. Small doses of ultrasound energy will be given to help confirm proper targeting in the brain.
You will be given a 'Stop' button to hold during the procedure, so you can pause the treatment at any time. Cool water from your helmet will circulate around the top of your head to prevent heating from the ultrasound.
During Treatment
During the sonication treatment, your physician will ask you questions and have you perform tasks like writing or tracing lines to confirm the tremor is improving.
Once your physician is confident of the location, the focused ultrasound energy will be increased in the same location to make the improvement in tremor permanent.
The procedure typically lasts a few hours. The time depends on many factors including density of your skull.
After Treatment
After coming out of the MRI machine, we will remove the frame from your head before scanning a few more images to confirm the location of the treatment. After these images, you will be moved to a recovery room. Most patients will be able to go home later that day.
Before discharge, monitoring equipment will be removed and you will receive specific discharge instructions from your doctor. Usually nothing is required, although your doctor may recommend steroids.
Your physician will let you know when you need to return for any follow-up visits. You will also be told whom to contact in case of an emergency after the procedure.
Our Focused Ultrasound Team
Benefits of MR-Guided Focused Ultrasound
Patients who have had this procedure have immediately seen their tremor significantly reduced, which has improved their ability to perform daily activities, such as eating, drinking, and writing.
There are many benefits to undergoing a focused ultrasound procedure:
- It's a non-invasive therapy with an almost immediate effect on symptoms.
- It reduces your risk of infection and damage to non-targeted areas of the brain.
- No incisions (cuts), burr holes through the skull, or electrode insertion into the brain are required.
Risks & Side Effects of MR-Guided Focused Ultrasound
It is possible, but unlikely, that you will not gain any tremor relief or improvement in life after this procedure. The procedure also does not treat or prevent progression of the underlying disease.
You may experience the following complications and side effects:
- You may have short periods of dizziness, pain, headaches, or other sensations during treatment, which end shortly after treatment.
- You may have temporary or permanent tingling in your fingers or elsewhere in your body. These sensations are typically mild to moderate and can last as briefly as the length of the procedure or up to several days.
- You may have nausea or vomiting.
- You may have bruising in the area of the IV following the procedure, similar to that experienced after blood draws. Any bruising should heal within a week.
- You may have changes in sensation or strength on the side of the body treated. This is most common several days after the treatment and typically improves after several weeks.
There is also a chance that your tremor may return some months or years after treatment. You should discuss any questions concerning risks and/or complications of the procedure with your doctor.
Patient Requirements for MR-Guided Focused Ultrasound
You must have a confirmed diagnosis of essential tremor or parkinson's disease to be referred for an MR-guided focused ultrasound. Your doctors will also want to be sure that you have tried at least two medications and found that they do not help you and/or have undesirable side effects.
In addition, you must be at least 22 years old. Since the procedure is done in an MRI scanner, there is a physical weight limit, generally in the range of 350 pounds.
You may not be able to have treatment if you have the following conditions:
- Claustrophobia
- Pregnant
- Allergic to the contrast dye used during MRI imaging
- Not generally healthy enough to go through the treatment and lie still in the same position for about three hours
- Certain heart conditions
- Extensive scarring on your scalp
- Skull tumors
- Severe hematological, neurological, or other uncontrolled disease
- Metallic implants. including
- Pacemakers (some are MRI-safe)
- Neurostimulators
- Some metal clips in your brain
- Some cranioplasty devices
Any metallic implants must be non-magnetic so you won’t be injured by the strong magnetic field from the MRI.
Your doctor can discuss all these conditions with you to determine if you are able to have the procedure.
Please have your primary care provider or neurologist (preferred) send a referral to be evaluated for the MR-guided focused ultrasound treatment for tremor. All referrals must be faxed to 801-585-6087. If you have questions about the referral process, evaluation appointments, or procedure, please contact our nurse coordinator at 801-213-0977.
