Focused ultrasound is an incisionless treatment for essential tremor patients who have not responded to medications. It is based on MRI-guided focused ultrasound (MRgFUS) technology. Our providers use MR imaging to guide sound waves so they can treat precise spots deep in the brain.

Unlike a diagnostic ultrasound that uses low-energy waves to capture pictures, focused ultrasound uses high-energy waves for treatment.

The FDA approved HIFU for treating essential tremor at the end of 2016 and for treating a patient’s second side essential tremor in 2022.

The limitation is based on the FDA approval. The FDA based its decision on the results and criteria of a clinical study.

The treatment is FDA approved to treat hand tremor.

The treatment is FDA approved for staged unilateral treatment — treating one side at a time with at least nine months between treatments. It is approved for eligible patients who experience no significant clinical events from the first treatment.

The ultrasound waves pass through the rest of the brain, but they only come together in the thalamus. Consequently, the temperature increase needed to create a lesion that disrupts the cause of your tremor only occurs in that spot.

It’s possible, but rare. MR imaging allows the treating physician to continuously see the treatment area and monitor the temperatures.

To be a candidate for the incisionless treatment, you must be diagnosed with essential tremor that either doesn’t respond to medication or isn’t eligible for at least two standard-of-care medications. Please discuss with your physician.

Yes, you need to have a definitive diagnosis of essential tremor. Your healthcare provider, primary care physician, a neurologist or a movement disorder specialist can provide this diagnosis. See other criteria below and discuss with your physician. Call us to schedule an appointment with one of our specialists.

Everyone’s skull is different. Your specialist will complete a CT scan to determine if the shape and thickness of your skull are suitable for the incisionless treatment. Certain skull shapes and thickness may make it impossible for ultrasound waves to reach the temperature at the target required for treatment.

Typically, you’ll meet with your treating physician at least two times. At the first consultation, the physician will evaluate your CT scans to determine whether you are a candidate for the treatment. The second time is on treatment day.

In some instances, you may meet a third time for follow-up imaging on the day after treatment. The treating team will also discuss any additional follow-up visits needed, as well as information that will be relayed back to your referring physician.

This is necessary for two reasons:

• Ultrasound waves do not travel well through hair. In this treatment, water is used (like a gel used when having an abdominal ultrasound) as a conductive medium. The smooth-shaven scalp and a silicone cap enable a tight interface with the ultrasound transducer.
• Air bubbles could get trapped in the hair, blocking the ultrasound waves and absorbing energy which could potentially lead to skin burns.

The frame is a standard stereotactic frame that helps ensure your head does not move during the treatment.

No, you will be inside the scanner from about your mid-torso up.

No, the treatment bed will move in and out of the MRI scanner. After each application of energy, your tremor will be assessed by doing various tasks, such as drawing a spiral.

Your feedback during the treatment is necessary as you will be asked to do different neurological tasks, such as drawing spirals. This is so the physician can evaluate the improvement of your tremor. They can also identify and address any potential side effects that you may be experiencing during the treatment.

The treatment time is on average two-and-a-half hours. Most people undergo the treatment on an outpatient basis. Your treating physician will decide when you can return home.

The most recent data shows hand tremor improvement of the study subjects was mostly maintained at three years*. Everyone’s experience is different. Your tremor may return after months or years. Or your tremor may not improve at all. It’s also important to understand that this treatment is only intended to improve your tremor. It does not treat your underlying disease or stop its progression.

*Pre-Market Approval (PMA) P150038 https://www.accessdata.fda.gov

That depends on the type of work that you do and how you feel. Please consult with your physician.

The treatment team will provide you with instructions related to your post-treatment recovery.

If your first treatment was at least nine months ago, you may be eligible to have the second side treated. Contraindications for treating the second side after initial HIFU treatment include:

• Abnormal speech function
• Difficulty swallowing (dysphagia)
• Gait abnormalities (moderate-to-severe)