Mrgfus Focused Brain Ultrasound
Watch this remarkable video of another one of our MRGFUS patients who has benefited from their treatment under the watchful eye of our team. His tremor is treated and you can see the control he now has over his shaking immediately post procedure.
MRI-guided Focused Ultrasound is noninvasive treatment, used primarily to treat essential tremor, tremor-dominant Parkinsons disease, and certain types of chronic pain.
After a single treatment, most patients report an immediate relief or significant improvement in their symptoms.
Focused ultrasound can penetrate the skull without the need to make an incision or drill holes in the skull.
Precision can offer short wait times for MRgFUS. We can see you within four weeks for a consultation and, if suitable, administer your treatment within three months of you contacting us.
If you have additional questions, please email .
Focused ultrasound is an innovative neurosurgical platform which delivers ultrasound energy deep in the brain with incredible precision.
This deliberately creates a small scar or lesion in the brain without incisions.
This procedure is carried out without anaesthetic or incisions.
The neurosurgeon and neuroradiologist sit at a computer console in the MRI control room, using a computer and mouse instead of a surgical scalpel.
But, at the focal point, the multiple beams of focused ultrasound energy converge, and this results in many important biological effects.
Have a question? Email your referral or enquiry to .
A New Era For Parkinson’s Disease Treatment
“A diagnosis of Parkinson’s disease no longer automatically portends a future of extremely limited physical capabilities. Thanks to the commitment of researchers like Dr. Eisenberg and Dr. Fishmanand clinical trial participants like Steve Squirestreatment has expanded to include non-invasive options that significantly reduce certain symptoms within minutes and transform the lives of people who had been living with debilitating symptoms,” said Bert W. O’Malley, MD, President and CEO of the University of Maryland Medical Center.
“Our school of medicine researchers have established themselves as world leaders in pioneering MRI-guided focused ultrasound for many devastating brain diseases, including Parkinson’s and essential tremors,” said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. “The stellar work of Dr. Eisenberg and Dr. Fishman has led to a new era in which this breakthrough modality has now become the standard of care for patients looking for less invasive treatments for their symptoms.”
Ventral Intermediate Nucleus Thalamotomy
Adverse events that transiently occurred during sonication in PD patients included the following: short lasting vertigo , headache , dizziness , nausea , burning scalp sensation , and lip paresthesia . Adverse events that lasted after the procedure included the following: asthenia , gait ataxia , unsteady feeling , unilateral taste disturbances , and hand ataxia . No adverse event lasted beyond 3 months. For a complete list of adverse events reported in this paper which also included essential tremor patients, see .
Lesions in the planned target were close to spherical with a diameter of 49mm . We observed mild edema one day after the procedure with increased edema one week after the procedure. The edema lasted for 35 weeks following the procedure. At 3 months, the edema resolved and lesion decreased in size.
The mean maximal temperature at the target was 56.5 ± 2.2°C . Patients underwent on average 21.1 ± 8.3 sonication with an average maximal sonication time of 16.2 ± 3.0 seconds . The mean maximal energy reached was 12,750 ± 4385 Joules .
Recently, Bond et al. reported in abstract form preliminary results of their double-blinded, randomized controlled trial to investigate the effectiveness of MRgFUS thalamotomy in tremor-dominant PD. They found that MRgFUS showed a trend toward improvement in hand tremor and a clinically significant reduction in mean UPDRS. They also noted a significant placebo response. Further information regarding this study is not yet available.
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Thank You One Last Question: If You Had To Share One Quote About Mrgfus What Would It Be
Our ability to help people get better, live the lives they want to for longer, and in the way and fashion they want to is only getting better through science and technology. Focused ultrasound is a great example of that. Reaching out and challenging the opportunities for yourself and your loved ones is important. Ask about these therapies and make sure your neurologists, neurosurgeons, and caregivers understand what the best opportunities are for you. Think of focused ultrasound as one element of the journey to wellness certainly, one that we are very happy to bring to Parkinsons patients and their families.
Treatment plans are collaborative. It is clear that Desai is an advocate for patients understanding available treatment options as they continue to emerge. With education, we can advocate for ourselves and be part of the plan.
Three Advantages Of Mrgfus For Pd Tremor
MRgFUS is a noninvasive outpatient procedure. No scalpel is needed to cut skin, no drill is needed to bore a hole in the skull, and nothing is implanted in the brain. Its three main advantages for PD-related tremor are:
A few words of caution: MRgFUS is not effective in every case. As with MRgFUS for ET, treatment will be directed to the hand in which tremor is worse, since treating both hands increases the risk of side effects. Clinical studies show that some patients have short term side effect such as headaches, dizziness or nausea but these quickly resolve. However, the effect may not be durable. Patients who have suffered with significant tremor for years may experience less effective tremor control, or gradual recurrence of tremor. Finally, MRgFUS does not cure PD, nor will it have an effect on other PD-related problems.
However, the consensus among researchers is that MRgFUS is a very promising treatment for PD-related tremor, especially as an alternative to invasive surgical procedures. If you or a loved one suffers from severe PD tremors, contact the Sperling Medical Group for more information about MRgFUS.
- CATEGORY:
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For Tremor Dominant Parkinson’s Disease
Parkinson’s disease is the second most common neurodegenerative condition, affecting about 1% of people over 60 years old. MR-guided focused ultrasound has become an attractive treatment option to improve tremor control for patients who do not respond to dopamine replacement medications.It is essential to recognize that focused ultrasound is not a cure for Parkinson’s disease, and it does not stop the progression of the disease. Some motor symptoms such as balance difficulties, speech problems, swallowing difficulties, and cognitive decline develop or worsen as Parkinson’s disease progresses and usually do not improve with focused ultrasound. Similarly, the non-motor complications of Parkinson’s disease, such as depression, problems with thinking or memory, constipation, or urinary changes do not improve after focused ultrasound.
+how Do I Request An Initial Consultation
If you are suffering from Essential Tremor, Parkinsons disease or another type of tremor or movement disorder and would like to know whether you might be suitable for treatment with focused ultrasound, please request a consultation and our clinical care coordinator will contact you:
Alternatively, please email your referral or enquiry to
Our assessment process includes:
- Confirmation of your diagnosis and its impact on your quality of life.
- Other relevant medical condition and medications you are on.
- Brain scanning with MRI and CT
Our clinical assessment team includes a movement disorder neurologist and neurosurgeon.
Our clinical care coordinator will coordinate all aspects of your assessment from the time we receive your referral. If you have any questions, please contact us.
Precision can offer short wait times for MRgFUS. We can see you within four weeks for a consultation and, if suitable, administer your treatment within three months of you contacting us.
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Focused Ultrasound For Essential Tremor And Parkinsons
OHSU is the only Oregon hospital to offer focused ultrasound for essential tremor and tremor-dominant Parkinsons disease. This life-changing treatment improves tremor symptoms for most patients right away. Benefits include:
Advanced technology thats safer for you. This treatment combines ultrasound with MRI. This means we can do surgery without an incision while youre awake. No cutting means no risk of problems like infection. Being awake means no anesthesia and you can see results in real time.
Improves your quality of life. Most patients have reduced tremor symptoms on one side right away. For more than 75% of patients, improvements were still there three years later.
Outpatient procedure. Most patients return to daily activities within a day. Temporary side effects of the treatment stop within a week.
To schedule an evaluation for focused ultrasound treatment for essential tremor or tremor-dominant Parkinsons disease, call our clinic at , or email us at .
Tremor Control Through Neurosurgery
Essential tremor is a movement disorder that most commonly affects the hands, head and voice. Since our hands are involved in practically every personal, professional and recreational task, the shakes create disabilities that range from annoying or frustrating to severely impairing. While medication is the first line of treatment, it is ineffective for about 50% of people among those who find it effective, a large number have to increase doses over time until eventually medication no longer works. When tremors resist drug treatment, it is called refractory ET.
Those who develop refractory ET are usually encouraged to consider a neurosurgery to control tremors. Such procedures intervene in the brains thalamus, a center that forwards abnormal tremor signals out to the body. There are two types of procedures:
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Continuous Subcutaneous Apomorphine Infusion
Apomorphine is a dopamine agonist with a mixed affinity for D1 and D2 receptors and an affinity for serotonergic and alpha-adrenergic receptors . While the motor efficacy of apomorphine is similar to that of levodopa, apomorphine cannot be administered orally due to its low oral bioavailability . Subcutaneous infusions have a similar pharmacokinetic profile to the intravenous route. Compared with intermittent subcutaneous injections, CSAI has a longer apparent plasma half-life and simulates the physiological stimulation of striatal neurons .
Clinical outcomes of CSAI
In the OPTIPUMP cohort study, the efficacy and safety of CSAI were assessed. The total UPDRS score showed significant improvement in all patients at 6 months. UPDRS-III decreased in the on-medication state by 16.3% . In the first prospective, randomized, placebo-controlled trial to investigate the efficacy and safety of apomorphine subcutaneous infusion in PD patients, a daily off time reduction of 1.89h from a baseline of 6.69h was seen in treated patients, while there was an increase of 1.97h in on time without TSD from a baseline of 8.52h . In a retrospective study, 230 patients were treated with CSAI over 10 years. In this cohort, the daily off hours were reduced from 5.4 to 1.2h .
Safety of CSAI
Patient considerations for CSAI
Who Can Have Mri
MRI-guided focused ultrasound may be a treatment option for people with essential tremor or with Parkinsons disease when hand tremor is the primary symptom and medications have not worked. Patients with essential tremor must be at least 22 years old and patients with tremor-dominant Parkinsons disease must be at least 30 years old to receive this treatment.
MRI-guided focused ultrasound is not suitable for all patients. You may not be eligible if you have:
- Metallic implants such as a pacemaker, neurostimulator, spine or bone fixation device, total joint replacement, metal clips, screws or cochlear implants
- Heart or spine issues that may make it difficult to tolerate the treatment or lie still for about 3 hours
- Extensive scarring on your scalp
- Tumors inside your skull
What is the Neuravive treatment? Neuravive is a new treatment for essential tremor where sound waves are focused through the skull to a target without the need for incisions, brain implants or radiation. It is based on high intensity focused ultrasound guided by MR imaging. During the procedure ultrasound waves pass through the skull and are focused on a specific target in the brain. The temperature at the target rises high enough to create a tiny ablation or burn and provide a therapeutic effect, reducing the hand tremor. The MRI scanner provides images for the physician to clearly see the treatment area and provides images that show changes in temperature at the target.
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+what Are The Benefits Of Focused Ultrasound
- It is non-invasive, with generally lower major risks than open surgery and a shorter recovery time
- It is carried out as a single treatment. Patients typically recover rapidly and quickly return to their usual daily activities
- Focused ultrasound frequently offers rapid improvement of symptoms. Other technologies such as Gamma Knife radiosurgery have a significant delay before clinical improvement is seen, and deep brain stimulation requires regular programming of the electrical device, and either frequent recharging or further surgery to replace the battery when it expires
- In contrast to stereotactic radiosurgery lesioning, focused ultrasound does not use radiation, thereby avoiding the side effects of radiotherapy.
- No anaesthetic is required, therefore patient with significant medical comorbidity are eligible for this treatment
Patient Story: Focused Ultrasound And Parkinsons Disease
It all started with a tiny tingle and I worried it was a sign of something bigger.
I was at a chili taste-testing contest when I reached to pick up a glass of hot apple cider and my baby finger tingled.
In that moment, I was concerned it was Parkinsons disease.
I had a feeling because my dad had had Parkinsons.
Over time I began noticing changes. My hand and arms started to tremor and my handwriting got progressively worse.
When my neurologist first gave me my diagnosis, I didnt want to believe it was Parkinsons. I wanted to fight it and beat it.
I still do.
Right now, there is no cure for Parkinsons disease. Its a progressive disease and its symptoms such as stiffness and tremor worsen over time. Each person with Parkinsons disease, experiences it differently.
For me, living with Parkinsons is a challenge. My main symptom is dyskinesia, which can include fidgeting or body swaying. My body isnt always doing exactly what I want it to do. Each day is different and depends on how my body is reacting to the medication that Im taking to help ease my symptoms.
I ended up retiring early from my job as a private school secretary. Day-to-day tasks take a bit longer to do, but I want to do things myself and I just take breaks when I need to.
The first participant of a world-first clinical trial
While some parts of my life are different, what hasnt changed for me is how determined I am to help in the search for a treatment or cure for Parkinsons disease.
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Who Do I Contact For More Information About This Focused Ultrasound Clinical Trial At Sunnybrook
Eligibility to enrol in Phase I of this trial include:
Patients with a diagnosis of Parkinsons disease aged 35-73 years old.
Canadian residents only, due to the inpatient stay involved
Participants will receive three doses of the therapeutic and application of focused ultrasound, every two weeks and will return for clinical imaging follow up at one, three and six months after the final focused ultrasound procedure.
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How Do I Know That Mr
Your medical team will conduct a complete assessment of your condition, conduct any needed addition tests, and then discuss if you are a candidate for this or other treatment options .
Generally, MR-guided focused ultrasound may be an option if:
- You have a confirmed diagnosis of essential tremor or tremor-dominant Parkinsons disease
- Have tremors that have not been relieved by medications
- Have tremors that limit your ability to perform daily activities
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Is Focused Ultrasound Right For You
If your tremor is impacting your quality of life and medicine isnt helping, then focused ultrasound may be an option for you.
This treatment works best for patients who:
- Have tremor symptoms that are worse or advancing faster on one side than the other.
- Take anti-coagulants or have other conditions that make options like deep brain stimulation dangerous. You and your doctor will decide if you should stop blood thinners before focused ultrasound.
- Do not want to have invasive brain surgery or commit to the ongoing adjustments that deep brain stimulation requires.
This treatment does not work for patients who:
- Cannot have an MRI due to implanted metallic devices , body weight greater than 300 pounds, or allergies to MR contrast agent.
- Have a high skull density ratio. About 15 percent of people have skulls too dense for this treatment.
- Have a history of abnormal bleeding, or conditions like advanced kidney disease, unstable cardiac disease, severe high blood pressure, or certain brain problems.
- Are unable to tolerate being still for the three-hour treatment.
Rapid Reversal Of Symptoms
Focused ultrasound is a completely incisionless procedure, performed without the need for anesthesia or an in-patient stay in the hospital. Patients, who are fully alert, lie in a magnetic resonance imaging scanner, wearing a specialized energy conversion helmet for the procedure. Ultrasonic energy is targeted through the skull to the globus pallidus, a structure deep in the brain that helps regulate voluntary movement. MRI images provide doctors with a real-time temperature map of the area under treatment.
Often before the procedure is even completed, patients experience relief from severe symptoms such as tremors, rigidity in the legs and arms, and side effects from medications that cause involuntary, erratic movements called “dyskinesia.”
About one million Americans have Parkinson’s disease, a neurodegenerative disorder that affects brain cells or neurons in a specific area of the brain that produce the brain chemical dopamine. Other current treatments for Parkinson’s include medications and deep brain stimulation from surgically implanted electrodes.
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