Magnetic Resonance guided Focused Ultrasound (MRgFUS) brings together two innovative technologies.

Focused Ultrasound waves, which provide the energy to treat tissue deep in the body with no cutting of the skin or skull.
Magnetic resonance imaging, which is used to identify and target the treated tissue, guide and control the treatment in real time, and confirm the effectiveness of the treatment.

Not everyone with essential tremor is eligible for focused ultrasound; eligibility requires evaluation by a neurologist and a neurosurgeon who has been trained on the technology.

Exablate Neuro

More than 4000 patients have been treated with this technology at more than 50 treatment centres worldwide. Although new to Philippines, Exablate Neuro is already being used to treat Essential Tremor in treatment centres across Europe, Asia and the United States. World leading hospitals in medical practice and technology such as Mayo Clinic, Stanford University Hospital, Brigham and Women’s (Harvard) and The Imperial College London have adopted the technology. Currently, more cases of essential tremor are being treated worldwide by means of transcranial ultrasound than by open surgery or radiation.(1)

During treatment, a lesion approximately 5mm x 5mm in size is made in the thalamus – the part of the brain believed to be part of the ”circuit” that causes tremor. Creating a lesion has been shown to interrupt this circuit.

Using MRI, the physician can clearly see the treatment area as well as monitor temperature changes. Initially, ultrasound energy delivered to the target slightly raises the temperature causing temporary effects and allowing the clinician to check for control of the tremor and any side effects. Only after the location has effectively been determined, the temperature at the focal target is increased to complete the treatment.

How the treatment works

Step 1:
Patient Preparation

Step 2:
Stereotactic planning

Step 3:
Target Verification

Step 4:
Treatment

Before Treatment:

On treatment day, your head will be shaved so that nothing will interfere with the ultrasound beams. After local numbing medication is applied, a frame will be secured to your head and an elastic cap is placed to seal the helmet, where water is circulated.

As the treatment last about 3 hours, a urinary catheter is placed so you won’t need to go to the bathroom. Your heart rate, blood pressure and blood oxygen levels will be monitored throughout the procedure.

During Treatment:

During the treatment, you will lay down on the treatment bed inside the MRI scanner. The medical team will be in the control room and you will be conscious and able to communicate with them. Your head will be positioned in the focused ultrasound helmet which is filled with water, and you will have a blanket to keep you warm.

You will be given a “stop sonication” button if for any reason you want to stop the procedure. MR images are taken to plan the treatment.Your physician will first apply light doses of ultrasound energy to identify the right spot in your brain for treatment. Then full intensity ultrasound energy will be applied. The temperature at the target rises high enough to create a small ablation, or burn and provide a therapeutic effect, reducing the hand tremor. The treatment bed will move in and out of the MRI.After each application of ultrasound energy, you will be asked to do tasks such as drawing spirals. This is so the physician can evaluate the improvement of your tremor and any potential side effects. Although individual results may vary, you should notice improvement during the treatment itself.

After Treatment:

At the end of the procedure a final MRI scan will be done to assess the treatment. The frame will be removed and you will go to a recovery room.

Your physician will let you know when you can go home and when you will need to return for any follow-up visit.

Typically, within days you should return to normal activities.

Is Exablate Neuro right for me?

The Exablate Neuro treatment is intended for Essential Tremor patients who do not respond to medication.

It is important to consult with your physician to determine if the Exablate Neuro treatment is right for you, and gain a referral through to a clinician that has been trained on Exablate Neuro therapy and other traditional treatments, so that you can discuss all options and determine which is best for you.

As part of the evaluation process, your physician will need to determine the severity of your tremor and perform a full medical evaluation to assess your overall condition. This is necessary to ensure a safe and effective Exablate Neuro treatment for your condition.

If you are deemed potentially suitable, next you will need to undergo a CT scan, for a better assessment of your skull’s shape and density. This will allow the clinician to determine whether the ultrasound waves will be able to reach the target point in the brain.

Patients should be aware that the entire procedure is fully conducted inside an MRI scanner, which is the “eyes” of the clinician, allowing them to identify the proper location in the brain tissue, verify the effect and complete the final treatment. A frame is applied to keep the patient’s head still throughout the procedure. The patient remains awake as it is necessary to receive feedback from them during the procedure.

Other factors, including the presence of metallic implants, pregnancy or general health must be considered to determine if Exablate Neuro treatment is right for you.

Risks and Side Effects

There is a possibility that tremor may return after the therapy, or that it may not improve at all.

For short periods during treatment, a patient may feel nausea, pain or other sensations. There is a small risk that the patient could develop temporary or permanent muscle weakness, unsteadiness, sensory loss, or numbness or tingling in the fingers or elsewhere in the body.

Be sure to discuss with your physician all the risks involved with the Exablate Neuro treatment. In general, the side effects of the Exablate Neuro treatment are low, but as with any medical procedure, there are risks:

For short periods of time during the treatment you may experience dizziness, pain or other sensations.
There is the possibility that your tremor may return some months or years after treatment.
There is a small risk that you could develop temporary or permanent muscle weakness, imbalance and/or gait disturbance, sensory effects (tingling/numbness) in your fingers or elsewhere in your body, or other neurological side effects.
It is possible that your tremor may not improve.
This procedure does not treat the underlying disease nor prevent the progression of the disease.

It is important that you talk to your clinician and understand all the risks and benefits.

What is MRgFUS?