Focused Ultrasound

What are Essential Tremors?

Essential Tremor is the most common type of movement disorder that causes involuntary, rhythmic shaking of the hands, head, arms, legs or voice. Shaking can occur with simple tasks such as writing, drinking from a glass, or tying shoelaces. Essential tremor usually runs in families.

What is Focused Ultrasound?

Focused Ultrasound is an incisionless brain surgery using MRI and ultrasound to make a very small lesion in the ventral intermediate nucleus of the thalamus, the area of the brain responsible for the tremor.

Benefits of Focused Ultrasound

• Immediate tremor improvement
• Improvement in performing daily activities
• Improvement in quality of life
• Outpatient procedure, typically taking 3-4 hours.
• No incisions means decreased risk for infection
• There is no anesthesia given, patients must be awake and able to respond to the Neurosurgeon during the procedure.

When Should I Consider Focused Ultrasound?

Focused ultrasound is an incisionless procedure approved by the FDA for the treatment of essential tremor. The treatment uses high-frequency, high-energy sound waves to target and destroy a very small area of tissue deep within the thalamus, an area of the brain responsible for the tremor. This procedure is discussed with patients that have tried and failed medications due to side effects or ineffectiveness of the medication, and are not a candidate for deep brain stimulation. The procedure can only be done unilaterally, or on one side, typically on the dominant side or the side with the more prominent tremor. Patients also must complete a preoperative head CT scan to determine if skull density is sufficient to support sound transmission.

Interested patients will have the opportunity to have a virtual meet and greet with the physicians before scheduling the procedure. This procedure is performed at CHI Health St. Mary's. 

For more information call: (402) 873-9639 or 1 (800) 265-7430. Fax: (402) 873-6856

Am I A Candidate for Focused Ultrasound?

Good Candidates for Focused Ultrasound Include the Following:

• You have severe to moderate essential tremors that limit your daily activities such as the ability to eat, drink, or write, among others.
• You are over the age 22
• You have tried at least two medications for tremors.
• You have medication side effects from tremor medications, such as drowsiness or depression, or the medications you have tried for your tremor do not work to control your shaking.
• You have severe anxiety about conventional surgery for tremor

You Are Not a Candidate for Focused Ultrasound if:

• You cannot stop your blood thinning medications
• You cannot have an MRI
• You exclusively have head or voice tremor
• You have had a stroke in the thalamus (portion of the brain responsible for the tremor)
• You have Multiple Sclerosis
• You have unstable cardiac disease
• You are pregnant 

Preparing For Your Visit

Before you come to CHI Health St. Mary’s, a provider will evaluate you for suitability for Focused Ultrasound and answer any questions you may have.   

Destination Clinic

CHI Health Neurological Institute at CHI Health Immanuel offers true patient-centric care to a destination clinic. Destination clinic visits for the Focused Ultrasound Program work like this:

1. See the Neurologist: The patient will check-in at our Neurological Institute and start their morning by meeting with our neurologist who specializes in tremors. This visit will include a thorough examination, full history of the tremor along with medication tried. Then, the neurologist will determine if the patient is a candidate for Focused Ultrasound.  
2. Get Needed Tests: If the patient is a good candidate for Focused Ultrasound, they will complete the required head CT scan right after they meet with the neurologist. This is a required step in the planning process and is used to measure skull density. 
3. See the Neurosurgeon: Office visit occurs in the afternoon with the neurosurgeon following the completion of the CT scan.

What to Expect on the Day of the Procedure

Someone will call you prior to your procedure day to go over your medications and instructions. You will also receive an instruction packet in the mail. There are certain medications that will need to be stopped prior to your procedure, such as blood thinners and tremor medications.

Once you arrive at CHI Health St. Mary’s, you will be taken to your room after checking in. This is where you will be prepped for the procedure and your head will be shaved. Medications will be given through an IV to prevent nausea. A metal frame will be placed on your head to keep it steady during the procedure. You will lie down in an MRI machine for 2-3 hours. During the procedure, there will be constant communication between you and your surgeon. The surgeon will talk to you and have you move your hand to evaluate the tremor as he or she adjusts the settings on the machine. After the procedure, your tremor should be controlled in that hand.

After your procedure, you will need to follow up with your surgeon the next day. If you were instructed to stop your blood thinning medications, you will need to restart them a certain number of days after your procedure. You will be given discharge instructions after your procedure with directions on when it is safe to restart these medications. 

You may experience some common side effects such as difficulty with walking or sleeping. These side effects typically resolve within 6-8 weeks after your procedure, but you may be at increased risk of falling. Please be cautious when walking, and it is best not to drive for at least two weeks. Numbness in your hand, face, or tongue on the treated side may occur. There is no guarantee this will resolve. 

Severe side effects are rare. If severe side effects occur, please call your surgeon and report to the nearest Emergency Room or call 911. These may include:

• New, severe headache with nausea and vomiting
• New neurological symptoms such as vision changes, confusion, new weakness, slurred speech, or inability to control body movements.