MR-guided Focused Ultrasound (MRgFUS) for Essential Tremor

If you have essential tremor and medication is either not effective or you cannot tolerate the side effects, then you might be a candidate for MR-guided focused ultrasound (MRgFUS).

You should first speak to your neurologist to discuss all your treatment options, but the neurological team at Queen Square Imaging Centre will ultimately assess your suitability.

Call today to speak with a member of our team about our fixed-priced pre-assessment package.

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.

The procedure will take between 3–4 hours, but you will not be in the MRI scanner for this entire time. You will be moved into and out of the scanner after each application of soundwave energy to test your neurological functioning.

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 your head can be bolted into a protective frame (called a stereotactic frame) that keeps your head secure during the procedure.

The procedure itself is painless but some patients reported a slight headache or a feeling of dizziness. You will have an IV for the administration of pain medication or 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.

Clinical studies have shown an average 76.5% improvement in hand tremor, with results remaining consistent for up to three years.

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

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. 

Most reported side effects were reported as mild and resolved themselves in 30 days. These might include:

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

Overall, MR-guided focused utlrasound 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.

MR-guided focused ultrasound is an outpatient procedure, so there is no need to stay in hospital. Most patients are able to resume their normal activities within 24 hours.