For patients who have undergone specialist assessment and treatment using MR-guided focused ultrasound (MRgFUS) for either essential tremor or tremor-dominant Parkinson’s Disease, treatment has hopefully been a significant step towards improving functional mobility and quality of life.  Just as we aim to guide each patient through their first assessment for treatment, we aim to provide an equally personal service to our patients post-treatment. 

Through a combination of follow up appointments and direct access to our responsive team of treatment coordinators, our aftercare service ensures that we are monitoring patients not only for treatment outcome, but also identifying any side effects, so they can be managed effectively.  This article explains our approach to aftercare in more detail.

Immediately After the Procedure

When a patient attends the Queen Square Imaging Centre for MRgFUS treatment, their first follow up appointment will take place just 24 hours after.  At this appointment, our aim is to ensure that the patient has recovered from their visit and is not experiencing any unexpected side effects before they head home.

It is because of this 24-hour post treatment follow up that we ask patients to stay in a local hotel for one night post treatment.

If you would like to read more about recovery that is expected after treatment, our article Understanding Recovery After MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor or Tremor-Dominant Parkinson’s Disease explains more.

3 months post-treatment

Your next follow up appointment will be at 3-months post procedure, although it is important to remember that our team of treatment coordinators are always available to answer any questions or address any concerns in the meantime.

The 3-month consultation is usually a telephone consultation with one of our neurologists and will involve a discussion about how you are recovering after treatment, how your tremor has responded, and whether you are experiencing any side effects. 

Whilst rare, we do recognise the potential for some side effects after treatment.  These are typically mild and transient.  Some patients might find they have a slight numbness or tingling in the treated hand or around the mouth.  Some may also experience difficulty with balance.  For this reason, we strongly recommend that you have a walking aid to use, and that you continue to use this for the first few weeks to months after treatment to avoid any falls. 

These side effects should not be significant enough to interfere with your day-to-day activities and are usually temporary.  We normally expect these to have fully resolved by the time the patient comes for their 6 month follow up visit.  However, if you have concerns about any side effects, this can be discussed at your 3-month consultation, or indeed any time before.

6-Months post-treatment

At 6-month post-treatment, you will be invited to attend an in-person consultation in Queen Square with one of our neurologists.  This consultation involves a more in-depth assessment of your remaining tremor and any side effects.

Outcome data from the treatments we have performed so far has shown that by the 6-month follow up, half of patients experience only mild persistent side effects which do not hinder daily function.  The wider literature suggests that many of these side effects should ultimately resolve by the 12- month mark.

In addition to the consultation, we also use the 6-month follow up visit to repeat the MRI scan that we will have performed just before your treatment.  This MRI scan allows us to repeat the specialist sequences we use to create a map of your brain networks and enables us to assess the lesion created during your treatment.  We will make sure the healing process is as we expect.  We always arrange this on the same day as your consultation so that your visit is quick and convenient.

Treatment of the Second Side

At this 6-month follow up consultation, some patients will also ask about treatment for the second side of the brain (to treat the tremor in their non-dominant arm).  Second side treatment is now approved after a 6–9-month period has elapsed after the first treatment.  If you were interested in having a second treatment, let us know before you attend for your 6-month appointment, so that we can arrange an MDT consultation during the same visit.

12-Month post-treatment

At the one-year mark post treatment, we will once again invite you to Queen Square to meet with a neurologist who will assess your tremor and ensure that any side affects you may have been experiencing have resolved.

At this point, most patients are discharged from our service, back into the care of their own GP or neurologist.  However, we are committed to always providing seamless care and will have kept your local GP or neurologist informed of your progress throughout the entire process. 

Is there a cost for my aftercare?

In Queen Square, we aim to make the pricing of our services transparent and simple to understand.  As part of this commitment, the costs of all scheduled follow-up visits (including the MRI scan at 6-months) is included in the treatment package price.  There should be no added cost to you for your aftercare, unless you need added unexpected medications or diagnostic tests which are arranged privately.

Conclusion

Recovering from MR-guided focused ultrasound thalamotomy is a process that varies from person to person. However, we offer a combination of follow up consultations and scans over the period of one year following to treatment to monitor all patients.  This enables us to be sure that patients are recovering well, receiving maximum benefit from treatment and managing any side effects.