MR-guided Focused Ultrasound (MRgFUS) for Essential Tremor

If you are one of the one million people in the UK affected by essential tremor, you will know just how disruptive and debilitating it can be. Simple tasks like signing your name, drinking a glass of water or using your touchscreen phone become impossible without frustration or embarrassment.

But there is hope. For patients with a moderate or severe tremor that has not responded to medication, MR-guided focused ultrasound (MRgFUS) is a safe, cutting-edge new treatment that can help you regain control of your life again.

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What is MR-guided focused ultrasound?

MR-guided focused ultrasound is a safe, incision-less procedure for the treatment of essential tremor.

It combines two technologies — high intensity focused ultrasound (FUS), which is guided by magnetic resonance imaging (MRI) to destroy a small area of tissue in the brain responsible for the tremor.

The outpatient procedure takes about 3–4 hours and results are comparable to deep brain stimulation (DBS) — but without the risks of general anaesthesia and invasive surgery.

In successful procedures, patients see an average improvement of 75% in their hand tremor.

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In successful procedures, patients see an average improvement of 75% in their hand tremor.

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In successful procedures, patients see an average improvement of 75% in their hand tremor.

About essential tremor

Essential tremor is a neurological movement disorder that affects one million people in the UK and millions more worldwide.

People with essential tremor (ET) experience a rhythmic trembling that can affect their hands, head, legs, trunk and voice. Although it is commonly experienced in older individuals, essential tremor can affect anyone of any age, gender or race, and can begin as early as birth.

Sometimes confused with Parkinson’s disease, essential tremor is 8–10 times more common than Parkinson’s. It is a progressive neurological disorder, which means that essential tremor can become more severe over time, causing individuals to experience progressively worse symptoms that can have a debilitating impact on their quality of life.

While medication is the first line of treatment, an estimated 50% of people with essential tremor either do not find sufficient relief or experience too many side effects from the medication. For these individuals, more intensive essential tremor treatment options — including deep brain stimulation and MR-guided focused ultrasound — might be necessary.

Learn more about the symptoms, causes and treatment of ET in our essential tremor guide.

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Benefits of treatment

Incision-free

Low to no risk of infection

Fast recovery

Immediate results

No hospitalisation

How it works

In a traditional ultrasound, sound waves pass safely through the body to generate an image. The most commonly known example of this is an ultrasound image of unborn babies.

In focused ultrasound (FUS), the same sound waves are used, but a special device focuses the energy from over 1000 ultrasound sources, creating a point of intersection in a very precise spot in the thalamus. The focused ultrasound waves generate enough heat at this intersection point to create a permanent lesion in the brain tissue, interrupting the circuitry that is responsible for the tremor.

The MRI acts as the ‘eyes’ of the neurosurgeon, allowing them to see the brain in real-time, accurately pinpoint the correct target location and monitor the temperature of the ultrasound waves.

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About the process

The MR-guided focused ultrasound treatment will be carried out using our brand-new, start-of-the-art equipment at the Queen Square Imaging Centre.

Our friendly and professional staff will explain every step of this essential tremor treatment and ensure your comfort in every way possible.

Before the procedure, you will have your head shaved to prevent any obstruction of the sound waves. You will be given a local anaesthetic in the skin around your scalp so that a frame can then be secured to your head. This frame ensures that your head remains completely still while in the MRI machine.

During the procedure, you will be awake, which is essential for targeting the right area of the brain, assessing your improvement and minimising any potential side effects.

Throughout the treatment, you will be moved into and out of the MRI machine and asked to do simple tasks like drawing a spiral to assess your improvement. Our team will talk to you throughout the procedure and will be able to answer any questions or concerns you may have.

The results

Individual results may vary, but patients reported an average of 76.5% improvement in tremor severity in clinical studies. Patients who were unable to sign their name or drink a glass of water without spilling before entering the MRI scanner find themselves able to do these simple, everyday tasks immediately after the procedure.

Clinical studies show that tremor improvement was mainly maintained three years after the procedure.

Because the treatment does not involve incisions or general anaesthesia, you can typically return to your regular routine after one day, and no hospital stay is necessary.

Although MR-guided focused ultrasound is not a cure and does not treat the underlying cause of essential tremor, this essential tremor treatment offers hope for patients whose hand tremor has made everyday tasks difficult. The results have been life-changing for the more than 3,500 patients who have undergone the treatment since its approval.

Find out if focused ultrasound treatment is right for you?

Have you been diagnosed with Essential Tremor by a neurologist?

Yes

Are you taking medications for your Essential Tremor?

Focused Ultrasound treatment is currently only used for Essential Tremor. Would you like to arrange a consultation with a neurologist discuss your symptoms and concerns?

Do you want to be contacted to receive more information?

Do you have any known contraindications to MRI exam? (e.g. Non-MRI compatible implanted metallic devices, size limitations, claustrophobia etc)

If you would like to arrange a private consultation with one of our consultants to discuss your symptoms further, please click on the link to provide us with some contact details.

Focused Ultrasound treatment takes place within an MRI scanner. Therefore, you must be able to have an MRI scan safely to be eligible for treatment. Please contact us so that we can discuss your potential contraindication further.

Based on your responses, focused ultrasound may or may not be suitable for you. If you would like to arrange a private consultation with one of our consultants to discuss the option further, please complete this form to provide us with some basic details so that we can get in touch

Based on your responses, you could be a good candidate for pre-assessment for focused ultrasound treatment. Please complete this form to provide us with some basic details so that we can get in touch to explain the next steps.

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Is MR-guided focused ultrasound right for you?

If the effects of essential tremor are getting in the way of doing simple, everyday tasks, you may have become resigned to accepting help and watching your life spiral out of control. But you can regain control of your life again.

MR-guided focused ultrasound is a life-changing treatment that can restore your ability to do all those tasks you used to take for granted — from eating and drinking to writing and using your mobile phone.

Currently, MRgFUS is a treatment for hand tremor that is approved for one side only.

Our multidisciplinary team will work with you to make sure that you are a good fit for the treatment and answer any questions and concerns you might have about the procedure.

Are you a candidate for MR-guided focused ultrasound?

If any of the following statements apply to you, then MR-guided focused ultrasound might be a good choice for improving your essential tremor.

If your hand tremor has not responded to medication
If you cannot tolerate the side effects of medication
If essential tremor is preventing you from living your life the way you’d like

The first step toward choosing the right essential tremor treatment for you is to speak with your neurologist about your symptoms and treatment options, but it can be challenging to remember everything you want to discuss with your doctor in a single visit.

You can download our helpful guide and symptom diary here to aid in your conversation with your neurologist.

Are there individuals who are not suited for MR-guided focused ultrasound?

Not everyone is suitable for this treatment. You might not be a good candidate for MR-guided focused ultrasound if you:

have metallic fragments, metal implants or medical devices that are not MRI-compliant
have significant speech or gait impairment or cognitive decline
have extensive scarring on your scalp
cannot stop anticoagulant medication for a few days
are allergic to contrast dye
are claustrophobic or unable to be still for the duration of the treatment

We’ll be happy to speak to you about any questions or concerns you might have about the procedure. Call us today to find out more.

Our expert team

At the Queen Square Imaging Centre, we have a unique partnership with the National Hospital for Neurology and Neurosurgery (NHNN) — the UK’s largest dedicated neurological and neurosurgical hospital.

All MR-guided focused ultrasound treatments will be performed by a multidisciplinary team of expert partners from the NHNN.

Professor Ludvic Zrinzo

Consultant Neurosurgeon

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Mr Jonathan Hyam

Consultant Neurosurgeon

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Mr Harith Akram

Consultant Neurosurgeon

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Professor Patricia Limousin

Consultant Neurologist

Professor Tom Foltynie

Consultant Neurologist

Dr Tabish Saifee

Consultant Neurologist

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Dr Prasad Korlipara

Consultant Neurologist

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Transparent fixed-price packages

We offer a fully transparent, fixed-price service. The MR-guided focused ultrasound treatment is broken down into two distinct packages.

Our fixed price pre-assessment package includes:

A clinical examination
Multidisciplinary team meetings to discuss your suitability
All relevant diagnostic investigations (blood tests, MRI scan, CT scan)

Our MR-guided focused ultrasound treatment package includes:

Outpatient procedure
Follow-up appointment

Call today to learn more about our fixed-price packages for essential tremor treatment or read our patient information guide.

Frequently asked questions

How safe is MRI-guided focused ultrasound?

MR-guided focused ultrasound is considered a safe and effective treatment for essential tremor.

As with any surgical procedure, there are some risks, and your medical team can discuss those with you. Although the treatment is generally painless, some patients report mild headaches or dizziness during the procedure.

Most side effects, or adverse effects, occur within 30 days of the treatment. These might include:

Imbalance/gait disturbance
Numbness or tingling
Muscle weakness
Slurred speech

In the largest study performed to date, most reported side effects were reported as mild and resolved themselves within 30 days. There is a slight chance that some adverse effects could be permanent.

Overall, MR-guided focused ultrasound is a safe and non-invasive treatment for essential tremor. Compared to deep brain stimulation, MR-guided focused ultrasound offers comparable results with a reduced risk of infection and bleeding, and no damage to the non-targeted area.

Why do I have to be awake during the treatment?

You must be conscious during the procedure so that your neurosurgeon can accurately pinpoint the precise target location in the thalamus. You will be asked to do simple neurological tasks such as drawing spirals to assess your improvement and minimise any side effects.

Whilst remaining awake may seem unusual, you will be kept free from discomfort throughout the procedure with the use of some simple medications. Since no anaesthetic is required, you will also be able to go straight home after your procedure - no hospital stay is required.

How long does the procedure take?

What can I expect during the MRgFUS procedure?

Prior to the procedure, you will have your head shaved to prevent air bubbles from being trapped by your hair which interferes with the ultrasound waves. You will be given a local anaesthetic so that a lightweight frame (called a stereotactic frame) can be secured to your head. This frame keeps your head secure and still during the procedure. Whilst the frame can feel tight, there should be no pain.

The procedure itself is painless but some patients report a slight headache or a feeling of dizziness. You will have an IV for the administration of pain medication and anti-nausea medication if necessary.

During the procedure, you will be moved into and out of the MRI scanner and will be asked by the team to do simple neurological tasks to assess your progress. You will be given a ‘stop sonification’ button to press if you experience any pain or need to stop the procedure to speak with the team at any time.

What level of tremor improvement can I expect?

Through treatment, we aim to produce a significant, immediate and durable improvement in tremor, with minimal side effects.

A major clinical study published in 2022** reported an average 73% improvement in functional use of the treated hand, with results remaining consistent for up to five years.

In Queen Square, treatment outcome data from our own team has reported equally promising results, with an average 75% improvement in functional ability and 70% enhancement in scores used to assess quality of life.

It’s important to note that MR-guided focused ultrasound can vastly improve your tremor, but it is not a cure.

**Cosgrove GR, Lipsman N, Lozano AM et al. Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: 5-year follow up results. J Neurosurg. 2022;1-6

If the treatment is new, how do you know it’s safe?

MR-guided focused ultrasound has been in development for more than 10 years. In the US, it has been approved by the Food and Drug Administration (FDA) since 2016. In the UK, NHS England approved funding for MR-guided focused ultrasound for the treatment of essential tremor from April 2021.

Although using focused ultrasound to create the brain lesion is relatively new, the science behind the procedure has been in practice for almost a century. Surgeons have been creating lesions in the thalamus with more invasive methods to treat neurological movement disorders for decades. With the introduction of MRgFUS, the well-established medical practice of thalamotomy has become non-invasive, more precise and, ultimately, safer.

A major study looking at 5-year follow up data from treatment sites from across the world was published in the Journal of Neurosurgery in 2022. This study recorded 0% serious adverse events in the 3000 patients included in the study.

**Cosgrove GR, Lipsman N, Lozano AM et al. Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: 5-year follow up results. J Neurosurg. 2022;1-6

Are there any potential side effects?

As with any surgical procedure, there are some recognised potential side effects from MRgFUS. These should be mild and typically resolve themselves in 30-60 days post treatment. The wider literature recognises side effects that might include:

Imbalance/gait disturbance
Numbness or tingling
Muscle weakness
Slurred speech
Slight bruising from the IV catheter

Data reported by our own clinical service has recorded mild side-effects in 50% of patients (most commonly slight imbalance), but no patients have experienced side effects that are significant enough to hinder daily living. These side effects are typically fully resolved by the 6-month follow up.

Overall, MR-guided focused ultrasound is a safe procedure with minimal risk of infection and bleeding. There is a slight risk of non-reversible side effects if non-targeted brain tissue is damaged.

Do I have to stay in hospital?

How much does MRgFUS treatment cost?

Can I use private medical insurance to have MRgFUS treatment?

Our MRgFUS service for Essential tremor is recognised by several major UK based private medical insurers, including AXA, WPA and Aviva.

If you have a health insurance policy, please contact us to discuss whether you may be able to obtain coverage for the assessments and procedure.

The procedure code used by insurers for the treatment is A0321 (MRI-guided focused ultrasound (MRgFUS) thalamotomy for essential tremor).

Download our 'MR-Guided Focused Ultrasound for Tremor' patient information leaflet

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English version

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Arabic version

About Queen Square Imaging Centre

Providing specialist diagnostic imaging in Queen Square since 1985

The Queen Square Imaging Centre is Central London’s only dedicated independent neuroimaging facility.

With a specialist focus on the brain, spine and nervous system, our expert team of radiographers and highly specialised Consultant Neuroradiologists use our brand-new, state-of-the-art CT and MRI scanners to ensure that your scan and report are of the highest quality.

We work in partnership with the National Hospital for Neurology and Neurosurgery specialists to offer self-pay and insured patients fast access to high-quality examinations in unrivalled patient comfort and safety.

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If you would like to find out more information about our MRI services please contact us using the form below.

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