A new non-surgical treatment for trembling hands and feet? (MR-Guided Focused Ultrasound)

Do you or someone you know have tremors? Sometimes this can be so uncomfortable that you can't even hold a cup of tea properly or sign a document. Today, we're talking about a new treatment that can be done without surgery for those who have difficulty controlling this condition despite taking medication. This is called MR-Guided Focused Ultrasound.

What is MR-Guided Focused Ultrasound (MRgFUS)?

Simply put, this is a combination of two techniques. Think of it as the work of two very talented teams working together.

• Magnetic Resonance (MR) Imaging: This is the one that shows the way. We all know that MRI scans can take very clear, detailed pictures of the organs inside our bodies. During this treatment, these MRI images help doctors see exactly where in the brain they need to treat, and also monitor whether everything is going well during the treatment.

• Focused Ultrasound: This is the person who performs the treatment. Ultrasound is a high-frequency sound wave that our ears cannot hear. These sound waves can pass through tissues such as our skin, fat , and bone. In this treatment, more than 1,000 ultrasound beams are combined and focused on a small target in the brain that was detected by MRI. Then, only that targeted area heats up, creating a small burn (lesion). This destroys the abnormal tissue. But the surrounding healthy tissue is not harmed .

How does this treatment reduce tremor?

There is a part of our brain called the thalamus. It is like a train junction. It sends signals related to our body's movements and sensations back and forth. In diseases like Essential Tremor and Parkinson's, the functioning of this thalamus becomes abnormal. That is what causes tremors .

Let's learn about how the treatment works.

This may sound a little scary, but it's a very planned and safe procedure. You'll be awake the whole time, so you can talk to the medical team.

1. Preparation: On the morning of the treatment, your head will be shaved. This is because the ultrasound rays need to be in contact with your skin. Your heart rate and blood pressure will be monitored continuously.

2. Head Frame: Next, your head will be secured in a special frame to prevent it from moving. You will be given medication to keep you relaxed during this time, so there is nothing to worry about.

3. Cooling system: A silicone membrane is used to circulate cool water between your skull and the ultrasound device. This helps keep your head from overheating.

4. In the MRI machine: You will be made to lie down on the MRI bed. Your head will be fixed to the bed so you cannot move your head. Then, several brain scans will be taken to confirm the exact location of the treatment.

5. Starting treatment: Before starting treatment, your tremor will be assessed and you will be given a few small tasks to do, such as drawing circles and writing your name. These tasks will be repeated during treatment to see if your tremors decrease.

6. Control and safety: First, the ultrasound beam is sent at a low energy to make sure that the target is correct. Then, the energy is gradually increased. The brain is monitored at all times with an MRI. If you have a problem or feel uncomfortable, there is a button in your hand that can stop the treatment at any time .

Once the treatment is complete, all the equipment will be removed from your head and you will be transferred to the ward for observation. The entire procedure usually takes about 3-4 hours.

What are the benefits and risks of this treatment?

Like any medical treatment, this one has benefits and some risks.

Will this completely cure my disease?

This is a problem that many people have. No, unfortunately this will not completely cure your disease. This is only a treatment for the disease. That is, it controls the tremors, which are a symptom of the disease, but this treatment cannot treat the root cause of the disease or stop the disease from progressing.

Who is not suitable for this treatment?

This treatment is not suitable for some people.

• If you have metal devices implanted in your body that are incompatible with MRI (e.g. pacemakers, some joint replacements).
• If there are scars like pus galls on the skull.
• If there are tumors inside the skull.
• If you are a patient undergoing dialysis.
• If you have uncontrolled severe infections or other illnesses.
• If you can't stay still in the same position for about 4 hours.
• If you cannot stop taking blood thinners.

The final decision on whether this treatment is right for you will be made by your doctor and his/her medical team. They will thoroughly examine your condition and discuss with you what treatment is best for you.