Focused ultrasound is a noninvasive procedure to treat essential tremor, which can cause involuntary shaking in many parts of the body.
Focused ultrasound for essential tremor uses focused, high-intensity ultrasound beams to target the area of the brain causing tremors. Between 30 and 40 beams converge on a tiny area in the brain.
The treatment is highly accurate and effective. Most people see their tremors reduced or eliminated right away.
At an experienced center like the UPMC Neurological Institute, focused ultrasound has excellent outcomes.
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Focused ultrasound is a noninvasive treatment for essential tremor. It uses focused ultrasound waves to ablate — remove through burning — the area of the brain causing tremors, creating a lesion.
Focused ultrasound may be an option for people who have not seen improvement after trying multiple medications for essential tremor.
The treatment combines MRI and ultrasound technology to target the precise area of the brain causing tremors. Bilateral focused ultrasound can treat essential tremor on both sides of the body.
The procedure requires no incisions. People can expect quick results and a fast recovery.
The goal of focused ultrasound is to relieve tremors and other symptoms. An essential tremor causes rapid involuntary shaking, generally more than five times a second.
Essential tremors cause involuntary shaking that can affect various parts of the body. These tremors can make it difficult to walk, talk, or perform other daily tasks.
Focused ultrasound is not a cure for essential tremor. But it can provide quick relief from symptoms — and many people still see improvement years after the procedure.
Benefits of focused ultrasound include:
To be a candidate for focused ultrasound, you must:
In addition, you may be a candidate for focused ultrasound if you are not a candidate for deep brain stimulation. For example, if you are on blood thinners or cannot tolerate general anesthesia, focused ultrasound may help you.
You are not a candidate for focused ultrasound if you cannot:
The first-line treatment option for essential tremor is medication. But if you have tried multiple medications and still suffer from tremors, you may be a candidate for focused ultrasound.
Other potential treatment options include:
Deep brain stimulation.
Gamma Knife® radiosurgery.
The biggest potential risk of focused ultrasound is creating a lesion in an incorrect area of the brain and affecting brain and motor function. To help prevent this complication, your care team will perform multiple safety checks.
You may also feel side effects during and after the procedure. During the procedure, you may feel side effects like dizziness, nausea, and pain. These are generally mild, and your team will be there to take care of you.
Side effects after the procedure may include:
These side effects are generally mild and subside within a couple of weeks of the procedure.
Before the procedure, you will have a full neurological workup with a neurosurgeon. A member of our team will thoroughly explain the procedure and answer any questions you have. You will also have an MRI and CT scan, as well as a bone density study based on the CT.
Once you are scheduled for focused ultrasound, your team will give you instructions on how to prepare.
If you are on any medications, including blood thinners or prescriptions for your essential tremor, you may have to stop taking them before the procedure. You also should not eat anything after midnight the night before your procedure.
Your team will tell you when to arrive, where to go, and what to wear on the day of the procedure. To avoid complications with the MRI machine, you will have to remove anything metal, such as jewelry, watches, and glasses.
Focused ultrasound is an outpatient procedure that does not require a hospital stay. You should arrange transportation home for yourself after the procedure.
The focused ultrasound procedure takes one to two hours.
You will first go to a prep room. Your team will place an IV to deliver any medication you may need before or during the procedure. You will not be under general anesthesia, as you will be awake, but should not experience much pain.
A member of your care team will completely shave your head to avoid any disturbance of the ultrasound waves. The team will give you local anesthesia — numbing medication — on your scalp. They then will attach a frame to hold your head in place during the procedure.
Your team will also attach a crown-like device to your head. This device is filled with cool water and includes ultrasound transmitters. It allows your neurosurgeon to see the coordinates of every point within the brain.
You will then go to the focused ultrasound treatment area. You will lie down on a table that will move in and out of an MRI machine. Your neurosurgeon will be at a computer that enables them to see images of your brain and control the ultrasound beams.
First, your neurosurgeon will create a "test lesion" on the target area of your brain. The test lesion raises the temperature enough to make the neurons stop working in the target area but not high enough to create a permanent lesion. They then test your tremor to ensure they are in the right place.
Once your neurosurgeon is satisfied they have the correct target, they will raise the intensity of the ultrasound waves. The higher intensity will increase the temperature in that area of your brain enough to create a lesion. They will then move you out of the MRI machine and test your tremor by having you write your name, draw a spiral, or do another task.
If your tremor is significantly reduced, the procedure is finished. If not, the team can repeat their actions up to three times. Most people will see at least some improvement in their tremors during the procedure.
After the procedure, your team will remove the frame and the crown-like device from your scalp. You then will move to an observation area for a couple of hours. Your team will monitor your vitals and ensure you are well enough to go home.
You may notice some temporary side effects, such as balance problems when walking, a loss of taste, and numbness. These side effects generally go away within a couple of weeks.
You should notice an improvement in your tremor during and immediately after the procedure. It may take a couple of weeks for you to feel the full effect.
You should be back to a normal lifestyle within a few days to a week after focused ultrasound.
You should talk with your doctor about when you can do exercises and other activities, as those depend on your condition.
You will have a follow-up appointment with your neurosurgeon two weeks to a month after the procedure. A few months later, you will have a follow-up MRI of your brain. You will continue to have regular follow-ups with your neurology team.
If you are having focused ultrasound on both sides of your brain, you will have to wait at least a month between procedures.
Most side effects after focused ultrasound are minor and subside within a few weeks. You should call your doctor if your side effects do not go away or worsen.
Most people begin to see an improvement in their tremors during their treatment and continue to see improvement afterward. People may see up to an 80% improvement with their tremors.
However, while focused ultrasound can improve your tremors, it is not a cure for essential tremor. Over several years, your tremors may return. You should consult your neurosurgeon to see if you are a candidate for another focused ultrasound treatment when this occurs.
UPMC is one of a limited number of U.S. hospitals offering focused ultrasound for essential tremor. You can expect excellent outcomes from this procedure.
UPMC’s Comprehensive Movement Disorders Clinic, part of the UPMC Neurological Institute, is a national leader in clinical care and research. We offer comprehensive care for a wide range of movement disorders. Our team creates an individualized care plan for you that ensures you are getting the best care possible.
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