Let's learn about the latest non-surgical treatment for hand tremors (MR-Guided Focused Ultrasound).

Do you sometimes feel very uncomfortable with your hands shaking, unable to even hold a cup of tea properly? Or does someone you know suffer from this condition? There are no words to describe the pain and discomfort you feel when you are unable to do even simple things like sign a document or put some food in your mouth. Most of the time, some people get relief from the medications given for this, but for others, those medications do not work. So next is things like brain surgery. But who is not afraid when it comes to surgery? But don't be afraid, today we are going to talk about the latest and most amazing treatment method for this tremor that can be done without surgery, without any incisions.

What is MR-guided focused ultrasound?

This name may sound a bit complicated, but it's actually quite simple. Simply put, it's a treatment that combines two technologies.

1. MR (Magnetic Resonance) Imaging: This is the MRI scan you probably know. It's like a very clear map showing the roads and buildings inside our brain. Doctors can look at these MRI images and find the exact spot inside the brain to treat, down to the millimeter . It also helps them make sure everything is going well during the treatment.

2. Focused Ultrasound: Ultrasound is a high-frequency sound wave that we cannot hear. Just like when you were a child, you would focus the sun on a piece of paper and burn it. This technology focuses more than 1,000 sound waves at the same time on a tiny target inside the brain. Only the point where these sound beams are focused heats up, destroying the problematic cells there. Surprisingly, the healthy brain cells around them are not harmed.

That means, without opening the head, sound waves are sent from the outside and treated only where there is a problem inside the brain.

Who is this treatment good for? For what types of diseases?

The US Food and Drug Administration (FDA) has currently approved this treatment for two conditions.

• Essential tremor: This is a condition that many people have that causes their hands, head, or voice to shake. The shaking is especially intense when they are trying to do something. This treatment is available for people who cannot control their tremor with medication .
• Tremor-dominant Parkinson's disease: Although Parkinson's disease has many symptoms, for some people, tremor is the main symptom. This treatment is also suitable for such people.

How does this method reduce shaking?

This is a very interesting story. There is a part of our brain called the thalamus . This is like the main telephone exchange center in our country. Motor and sensory signals from different parts of the body are sent to other parts of the brain from here.

People with essential tremor and Parkinson's disease have a small defect in the circuits in the thalamus. That's why the wrong signals are sent and the hands start to tremble.

This treatment involves directing the ultrasound beam precisely to the location of the faulty signals and creating a tiny lesion there. It's like turning off a faulty switch. The faulty signals stop flowing, and the tremors almost immediately decrease or stop completely.

Step-by-step treatment process

Okay, now let's see what happens when this treatment is done. There's nothing to worry about, there are no cuts or bruises.

1. Preparation: On the morning of the treatment, your hair will be shaved completely. This is because the ultrasound waves need to be in contact with your scalp. Then, your heart rate and blood pressure will be monitored.

2. Head Frame: A special frame will be placed on your head to prevent your head from moving even slightly. During this time, you will be given a small amount of medication through a vein to help you feel less discomfort.

3. Into the MRI machine: You will then be sent into the MRI machine. You will not be able to move your head because of the frame that is attached to your head. The doctors will take scans of your brain and choose the right area to treat.

4. Testing: Before starting treatment, the medical team will ask you to draw circles, write your name, or do certain things with your fingers. This will measure the severity of your tremor.

5. Starting the treatment: Now is where the real work begins. First, low-energy ultrasound waves are sent to the target to make sure it is in the right place. After confirming it with an MRI, the energy is gradually increased.

6. Your response: You are awake while doing all this. You can talk to the medical team. They will always ask you how you are feeling. They will also ask you to do the same things you did before, like drawing and writing. You will notice that the shaking is decreasing right there.

7. Emergency stop button: There is an emergency stop button on your hand that you can press during the entire treatment. If you feel any discomfort, the treatment will stop as soon as you press it.

8. End: Once the tremors are well controlled, ultrasound waves are sent at the right intensity to completely mark the target. The entire process takes about 3-4 hours. After that, all the gadgets are removed from your head and you are transferred to an observation ward.

Results and advantages and disadvantages

The best thing about this treatment is that you can see the results right away. Research has shown that many people's tremors are reduced by 50% - 60% almost immediately.

Is everything okay? Are there no side effects?

As with any medical treatment, there are some side effects and risks, but most of them are temporary .

• Nausea and headache (during treatment)
• Temporary numbness in the fingertips or lips
• Slight clumsiness when walking, balance problems (temporary)
• Difficulty speaking or swallowing (temporary)

There are also several long-term risks .

• Tremors may recur months or years after treatment.
• Sometimes the tremors may not decrease at all .
• In very rare cases (about 10-15% of people), muscle weakness and numbness may remain permanently .

Who is this treatment not suitable for?

This treatment is not for everyone. It is not suitable for people with the following conditions:

• People with metal devices in their bodies (e.g. pacemakers, spinal rods, joint implants) because this is done inside an MRI machine.
• People with large scars on their scalp.
• People with brain tumors.
• People with kidney failure who are undergoing dialysis .
• People with severe medical conditions or infections that cannot be controlled.
• People who cannot stay still in the same position for 3-4 hours.
• People who cannot stop taking antiplatelet or anticoagulation therapy .

So, how do you know if this treatment is right for you?

This is the most important thing. You can't make decisions about this alone. You should talk to your neurologist about this.

Generally, you might be a good candidate for this,

• If you have been correctly diagnosed with Essential Tremor or Tremor-dominant Parkinson's disease .
• If your tremors are not controlled by the medication prescribed for you.
• If this tremor is interfering with your daily activities (such as eating, writing, drinking water) to the point where you can't do them .

Your doctor will examine you thoroughly, perform further tests if necessary, and explain to you whether this treatment, or another treatment such as Deep Brain Stimulation (DBS), is best for you.