The Newest Incisionless Treatment Helping Patients Find Relief from Essential Tremor
MR-guided focused ultrasound is a relatively new non-invasive outpatient procedure used to treat essential tremor. This incisionless brain surgery (which means no incision or cuts) is safe with minimal side effects using high-intensity focused ultrasound energy guided by magnetic resonance imaging (MRI), to heat a small, pinpointed tissue area in the brain. The procedure can reduce the tremor a patient may be experiencing in their hand almost immediately. Most patients are home the same day and it’s approved by the FDA and covered by Medicare.
More About the Procedure and Its Benefits
MR-Guided Focused Ultrasound is unlike any traditional surgery used to treat tremors because it can be performed on conscious patients inside an MRI scanner. With the scanner engaged, the doctor can more precisely target a small, pinpointed area of your brain (the VIM of the thalamus) that may be causing tremors. They can then precisely treat only the targeted area because the scanner measures with precision, the amplified brain temperature impacted by the ultrasound energy. Patients choose this treatment for a number of reasons:
- It uses targeted ultrasound energy.
- There are no incisions because ultrasound can pass through the body– skin, fat, bone and muscle.
- Ultrasound energy is non-ionizing. The patient isn’t exposed to potentially dangerous radiation.
What to Expect Before You’re Treated
You will be prepared for your procedure by meeting with a nurse who will clean and shave your scalp. You’ll be given any medications you need to feel more comfortable to alleviate anxiety and pain and to numb your head where the frame will be placed. With the numbing medication administered, your specialist will place a frame on your head to prevent your head from moving during the procedure. Then they’ll place a silicon membrane that circulates cool water on the head to minimize the heating near your scalp. Throughout the procedure, the medical team will monitor your vital signs including heart rate, blood pressure, and blood oxygen levels.
Before You’re Treated
Your care team will help you onto the bed on the MRI device. Remember, you’ll be awake during the entire procedure, so you’ll be able to communicate with both your doctor and your nurses. The physicians will be administering the procedure via computer near the MRI suite. Here, they can watch you both through the MRI suite window and via camera while your nurse monitors your vital signs. Your doctor will begin by running MRI images of the area they will be treating and giving small doses of ultrasound energy to help confirm that they are targeting the correct area. Every patient is given a Stop button that you will hold throughout the procedure so that you can pause treatment if you need to.
During Your Treatment
Count on the treatment lasting a few hours depending on the shape and density of your skull. As the treatment proceeds, your doctor will have you perform different tasks like writing or tracing lines on paper. They may also ask you questions to gain feedback to see if your tremor is improving. With this feedback and improved responses, your specialist will feel more confident of the location and increase the focused ultrasound energy in the pinpointed area making the improvements permanent.
After Your Treatment Has Been Completed
This is the easy part. Your care team will remove the frame from your head after they move you out of the MRI machine, but not before they scan a few more MRI images to assess the treated area of the brain. Now it’s on to recovery where your care team will remove the monitoring equipment. In discharge, your physician will give you specific instructions –typically they will include just over-the-counter pain relief medication to take as needed. You will likely be able to go home the same day and be able to resume normal activities within a few days. After you’ve been discharged, you’ll be given contact information for whom you should contact in case of an emergency.
If you suffer from tremors and think that MR-Guided Focused UltraSound is right for you, make an appointment by calling 832-340-2133 or emailing us at tremors@hphtx.org.
