Non-Surgical MR Guided Focused Ultrasound (MRgFUS)Treatment for Tremor
What is Essential Tremor?
Essential tremor is a neurological disorder characterized by involuntary rhythmic movement in specific parts of the body, such as the hands, feet, head, and voice.
It is ten times more prevalent than Parkinson’s disease and affects approximately 60 million people worldwide. Often mistaken for Parkinson’s, it manifests as.
What Are The Symptoms of Essential Tremor?
- Tremors during movement in the hands and feet.
- Head tremors while sitting or standing.
- Tremors in the voice during speech.
- Difficulty in tasks requiring fine motor skills like writing or buttoning clothes.
- Difficulty grasping or controlling objects such as a cup.
- Tremors exacerbated by stress.
What Is MRgFUS Treatment?
MRgFUS treatment is a non-invasive, non-surgical, safe, and advanced technology-based treatment method for Essential tremor and Parkinson’s disease, in which tremors are dominant. This technology utilizes a combination of 1,024 separate ultrasound waves with high-intensity and Magnetic Resonance Imaging (MRI) to target specific areas through the scalp and disable the regions in the brain causing the tremors.
Before
After
How Does MRgFUS Technology Work?
Ultrasound waves are focused on a small point called the “thalamus” which is believed to be the target site of tremors in the brain. Increasing levels of energy are delivered with these focused ultrasound waves. The energy is gradually increased until the patient’s symptoms improve, and the process is continued until the most effective dose is reached, creating a small lesion in the desired area of the brain similar to a laser effect, ultimately eliminating the tremors.
MRI enables real-time imaging of the brain, facilitating precise targeting and monitoring of the heat generated by the ultrasound waves.
What Is The MRgFUS Treatment Process?
Before initiating the MRgFUS treatment, the hair needs to be cut to prevent it from interfering with the sound waves. A frame is attached to the patient’s head to stabilize it and calculate the necessary coordinates. Local anesthesia is given during this procedure.
During the treatment, the patient remains awake to accurately target the right brain region, assess the healing condition, and minimize potential side effects.
Throughout the duration of the treatment, at certain intervals, the patient will be asked to perform certain actions such as opening and closing their hand, writing, while on the MR table. Our experienced team will communicate with the patient throughout the procedure to ensure a comfortable and convenient process.
What Is The Success Rate of MRgFUS Treatment?
Although individual results may vary, clinical studies have shown a high rate of improvement in patients after treatment.
After MRgFUS treatment, patients regain the ability to perform simple tasks such as signing or drinking without spilling. Clinical studies have demonstrated that tremor reduction can persist at least for five years or longer after the treatment.
Although MRgFUS treatment does not address the underlying cause of tremors, it provides hope for patients experiencing daily challenges and significant impacts on their quality of life due to hand tremors.
Is MRgFUS Treatment Safe?
MRgFUS (Magnetic Resonance-guided Focused Ultrasound) treatment is considered to be an effective and safe method for treating tremors. The procedure is generally painless, although some patients may experience mild side effects such as headache or dizziness. Within the first 30 days following treatment, potential side effects may include.
- Imbalance/difficulty walking.
- Lightheadedness and headache.
- Numbness or tingling.
- Muscle weakness.
- Slurred speech.
These possible side effects have been reported by patients to be mild in nature and mostly resolve within 30 days. Additionally, since the procedure is non-invasive, there is no risk of bleeding or infection. As there is no intervention outside the targeted area, other regions of the brain are not damaged.
Who ls Eligible for MRgFUS Treatment?
MRgFUS treatment is applicable for various tremor diseases, particularly Essential Tremor and Parkinson’s Disease. Suitability for treatment depends on evaluating the type and severity of the patient’s tremor, as well as their overall health condition. In addition, patients need to undergo a Computed Tomography (CT) scan to determine whether they are suitable candidates for MRgFUS treatment.
Patients with metallic implants in the head such as pacemakers, DBS, spinal or bone fixation devices, metal clips, screws, etc., may not be suitable candidates due to MRI compatibility concerns and potential harm from the strong magnetic field.
Individuals with compromised general health or who cannot lie still for approximately 1-2 hours during treatment may also be unsuitable candidates. Further limitations exist, and the decision regarding suitability for treatment is made by the doctor following necessary evaluations.
Who Are Not Candidates for MRgFUS Treatment?
- Those with non-MR compatible heart pacemakers or other metal device implants.
- Individuals with advanced kidney disease or undergoing dialysis.
- Patients with unstable cardiac conditions or severe hypertension.
- Those exhibiting behaviors consistent with alcohol or substance addiction.
- Individuals with a history of abnormal hemorrhage or cerebrovascular diseases.
- Patients with brain tumors.
- Individuals unable to tolerate or unwilling to maintain the necessary fixed position during treatment.
- Pregnant women.
Frequently Asked Questions
Am I a candidate for MRgFUS treatment?
If you have a tremor disorder and are no longer benefiting from your current medications, you may be a candidate for MRgFUS treatment. However, confirmation requires consultation with our doctors and specific procedures. Our experts will determine your eligibility based on evaluations conducted during the consultation.
Why do I need to be awake during the treatment?
You need to be awake during the procedure so that our doctor can precisely identify the target point in the brain that is causing the tremor. Additionally, your participation allows the doctor to ask you to perform specific actions, like opening and closing your hand or writing, to assist in the process.
How long does the procedure take?
The procedure typically lasts for around 3 hours. However, you won’t be inside the MRI machine for the entire duration. Throughout the treatment, at specific intervals, you will be removed from the machine while remaining on the MRI table to assess your neurological function. After necessary checks are conducted, you will then be guided back into the treatment unit.
What will I encounter during the procedure?
Before the treatment, your hair will be cut to ensure that it does not interfere with the sound waves. A frame will be placed on your head to stabilize it and calculate the necessary coordinates. Local anesthesia will be given during this process. Your pulse, blood pressure, and oxygen level will be measured during the procedure. Since you will be awake during the treatment, you will stay in communication with the treatment team throughout the process.
Do I have to stay in the hospital after the procedure?
MRgFUS treatment is an outpatient procedure. Most patients are discharged on the same day after the procedure and can resume their daily activities.
When will I recover?
Clinical improvement is often observed during the procedure. Most patients experience rapid improvement in their symptoms even while on the MR table concurrent with the progressive increase in energy waves.
How effective is the treatment?
Clinical studies have shown a high rate of improvement in essential tremor, with effects lasting up to 5 years. Patients benefiting from this procedure experience a significant increase in their quality of life.
If the effect decreases over time, can the procedure be repeated?
If sufficient effect isn’t achieved or if there’s a decline in effectiveness in subsequent years, your doctors may decide to repeat the procedure or explore other treatment options following a detailed evaluation.
Can this treatment be applied to patients with DBS?
For patients with DBS, MRgFUS Treatment cannot be performed. However, if the DBS was removed for any reason, MRgFUS Treatment can be considered.
Is the treatment only applied to one side, or can it also be applied to the other side?
The treatment is typically applied unilaterally, based on the patient’s symptoms and dominant hand. For instance, if a patient primarily uses their right hand and experiences tremors on the right side of the body, the treatment targets the left side of the brain. However, after a certain period, usually 6-9 months, the same treatment can be considered for the other side of the brain.
Does the treatment prevent other treatments such as deep brain stimulation surgery in the future?
MRgFUS Treatment does not prevent other treatments like Deep Brain Stimulation surgery. If necessary, the same method or different treatments can be applied to the patient depending on their condition and medical recommendations.