Focused Ultrasound for Essential Tremor

Imagine being able to write a card for a loved one again, to paint, to cook or simply being able to eat without help. Now, imagine recapturing all those cherished activities on the same day with an innovative, incisionless procedure.

UF Health’s nationally recognized neurology and neurosurgery experts do this for dozens of patients a year by treating essential tremor with focused ultrasound. This disabling tremor, a movement disorder that occurs during voluntary movement, affects the lives of more than 60 million people a year worldwide. UF Health is proud to offer this life-changing, leading-edge procedure that can reduce your tremor and safely restore your quality of life.

Focused ultrasound, or FUS, is an incisionless treatment option that has been approved by the FDA since 2016 to treat essential tremor of the hand, as well as those with tremor-dominant Parkinson's disease. The outpatient procedure is guided by magnetic resonance imaging, or MRI, using ultrasound waves to safely pass through a patient’s skull and precisely heat and destroy specific regions deep inside the brain that are involved in generating tremor. During the treatment, which lasts about two hours, you’ll interact with our expert team to make sure you achieve excellent tremor suppression with minimal side effects.

Is focused ultrasound right for me?

To be a candidate for FUS, you must meet the following criteria:

• Confirmed diagnosis of medication-refractory essential tremor (resistant to medication)
• Appropriate skull density
• Ability to tolerate lying flat within MRI for two to three hours
• No MRI-incompatible medical devices (e.g. certain models of cardiac pacemakers)

FAQs about focused ultrasound

How does the evaluation process work at UF Health?

A clinic appointment with neurosurgeon Dr. Justin Hilliard will be scheduled at the Norman Fixel Institute for Neurological Diseases. You will undergo a through neurologic exam and review of your clinical history. A CT scan of your head will be performed to measure your skull density. If you’re an appropriate candidate for FUS, a high-resolution planning MRI of your brain will be scheduled about two weeks prior to the date of your focused ultrasound procedure.

FUS targets the thalamus, which is near the center of the brain. How do the ultrasound waves avoid affecting the rest of the brain?

While the ultrasound waves do pass through other areas of the brain, the thalamus is the point where the waves meet (where they are focused). That’s where the temperature rises, creating a small ablation or burn that disrupts the cause of the tremor symptoms.

What are the risks and side effects of focused ultrasound treatment?

Side effects are typically minor and temporary. Generally they are caused by a small amount of swelling within the brain around the targeted region that can create some temporary dysfunction in the normal brain circuits. You may experience numbness or tingling, balance problems, issues with speech or swallowing. If they occur, these side effects typically resolve within one to two months. During the procedure, you may feel a slight headache, nausea, or dizziness.

If I have tremor in both hands, are they treated at the same time?

The treatment is FDA-approved for staged unilateral treatment. This means that only one side of the brain is treated at a time. For appropriate patients, the second side can be treated nine months later. Whether we’re able to treat the other side of your brain will depend on your health.

How long does it take to see results from the treatment?

You should notice immediate improvement in your hand tremor during the procedure.

What does recovery and follow-up look like?

After undergoing focused ultrasound treatment, you will be moved to the recovery room where you will be monitored for about an hour before going home.

While your care is specific to your individual needs, most patients will have a follow-up appointment around one month following the procedure. Most patients are able to wean off their tremor medications after treatment.

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