OHSU is the only Oregon hospital to offer focused ultrasound for essential tremor and tremor-dominant Parkinson’s disease. This life-changing treatment improves tremor symptoms for most patients right away. Benefits include:
Advanced technology that’s safer for you. This treatment combines ultrasound with MRI. This means we can do surgery without an incision while you’re awake. No cutting means no risk of problems like infection. Being awake means no anesthesia and you can see results in real time.
Improves your quality of life. Most patients have reduced tremor symptoms on one side right away. For more than 75% of patients, improvements were still there three years later.
Outpatient procedure. Most patients return to daily activities within a day. Temporary side effects of the treatment (such as nausea, imbalance, and numbness) stop within a week.
How does focused ultrasound work?
We use ultrasound to ablate (burn) the part of your brain that causes tremor. Using ultrasound means:
- No incisions. This technology lets us perform brain surgery without any cutting. This means no risk of bruising, bleeding or infection.
- Precision and accuracy. This technology lets us create a small lesion in the exact right place. Thousands of ultrasound waves come together in one place smaller than a millimeter. This creates enough heat to cause a lesion.
- Immediate feedback. Throughout the procedure, we test for improvement of your tremor symptoms so we know exactly when the procedure is complete.
What are the risks and limitations of focused ultrasound?
Focused ultrasound for tremor has minimal side effects. Some patients experience temporary side effects during and after treatment. It is rare for these symptoms to last more than a week.
The most common side effects are:
- Skin irritation on the scalp
- Imbalance or trouble walking
- Numbness and tingling
- Nausea and vomiting
- Muscle weakness
- Sensory loss
This treatment is effective for most patients, but there are limits.
- We can only perform the treatment on one side of your body. Your non-dominant side will still have tremor symptoms. Research is underway to learn if we can use focused ultrasound for both sides in the future.
- The treatment can vastly improve your tremor, but won’t stop it completely.
- This is not a cure. Essential tremor and Parkinson’s disease get worse over time and this treatment can’t stop the progression. You and your doctor can discuss if retreatment with focused ultrasound is best for you, or you can try another option like deep brain stimulation.
What to expect from focused ultrasound treatment
Before your focused ultrasound treatment:
- Meet with Dr. Ahmed Raslan, neurosurgeon, to discuss the benefits and risks of focused ultrasound. We will also evaluate your condition to make sure focused ultrasound is the right treatment for you.
- You will need an MRI before treatment. If you already had an MRI with your neurologist, you may not need another one with us.
On treatment day:
- When you arrive for treatment, we will completely shave your head. This makes sure that nothing will block the ultrasound waves.
- You lay on a table that can slide in and out of an MRI machine during the procedure.
- We use numbing medicine at four different points on your scalp, then use pins to attach a frame. This frame will make sure your head is completely still during the procedure.
- We fit your head into a water-filled helmet that has more than 1000 ultrasound transmitters.
- We will find a baseline by asking you to draw a spiral or touch your nose.
- We can view your brain and control the ultrasound waves from a computer.
- We start with a test lesion. This is a temporary change to confirm that we are in the right place in your brain.
- This outpatient procedure takes up to three hours. You will be able to go home that day or the next day.
- You may experience brain swelling in the area for up to a week. This could cause temporary numbness, imbalance, or other neurological issues.
- Improvement to your tremor symptoms is immediate during the procedure.
Is focused ultrasound right for you?
If your tremor is impacting your quality of life and medicine isn’t helping, then focused ultrasound may be an option for you.
This treatment works best for patients who:
- Have tremor symptoms that are worse or advancing faster on one side than the other.
- Take anti-coagulants (blood thinners) or have other conditions that make options like deep brain stimulation dangerous. You and your doctor will decide if you should stop blood thinners before focused ultrasound.
- Do not want to have invasive brain surgery or commit to the ongoing adjustments that deep brain stimulation requires.
This treatment does not work for patients who:
- Cannot have an MRI due to implanted metallic devices (like a cardiac pacemaker), body weight greater than 300 pounds, or allergies to MR contrast agent.
- Have a high skull density ratio. About 15 percent of people have skulls too dense for this treatment.
- Have a history of abnormal bleeding, or conditions like advanced kidney disease, unstable cardiac disease, severe high blood pressure, or certain brain problems.
- Are unable to tolerate being still for the three-hour treatment.
- Are pregnant.
Frequently asked questions about focused ultrasound for tremor
Focused ultrasound has only been used to treat tremor in the United States since 2016, but the method was studied for decades before it was approved.
While using ultrasound waves to create a brain lesion is a leading-edge technology, it is based on decades-old medical science. Surgeons have lots of experience creating brain lesions with more invasive methods, and have used ultrasound waves in medicine for about eighty years.
The most important reason is that ultrasound is incisionless. Focused ultrasound is brain surgery without an incision. No cutting means no risk of bruising, bleeding problems or infection.
We have many safety measures in place to make sure this can’t happen.
- The frame and helmet hold your head perfectly still.
- The MRI gives us real-time images of your brain.
- The ultrasound waves only create a lesion where they all come together. This focal point is smaller than a millimeter.
- You are awake during the procedure so we can use neurological tests to monitor your symptom improvement and any problems.
- We first create a temporary lesion and confirm it is in the right place before creating a permanent lesion.
Before the procedure, you will feel four needle pokes as we numb your scalp. You will not feel pain from the pins holding the frame or from the ultrasound waves during the procedure.
Focused ultrasound for tremor is covered by Medicare. If you do not have Medicare, please contact your insurance carrier. Some private insurance carriers (like Aetna, Premera Blue Cross and Regence BCBS) do cover this treatment.
We will work with you to help you choose the right treatment for your tremor. Your preferences, the severity and type of symptoms you have, and your lifestyle goals are all important factors to consider.
This chart is a quick guide comparing the two surgical treatment options we offer for essential tremor and tremor-dominant Parkinson’s disease.
|Focused ultrasound:||Deep brain stimulation:|
|Non-invasive with no incisions or risk of infection.||Two brain surgeries, each with incisions.|
|If you take blood thinners, you only need to stop taking them for a few days.||If you take blood thinners, you need to stop taking them for one week.|
|Outpatient procedure with no or short (one night) hospital recovery.||One-night hospital recovery for first surgery. No hospital stay for second surgery.|
|Can only treat one side.||Can treat both sides.|
|Whole head must be shaved.||Whole head must be shaved.|
|Results are immediate. You need just one post-procedure follow-up visit.||Follow-up visits are needed to program the implanted stimulator and make changes over time.|
|Lesion is permanent.||Stimulator implant can be turned off or removed.|
|Best for tremor that is worse or advancing faster on one side.||Best for tremor that is equal on both sides or in the center of your body (tongue or mouth).|
OHSU Neurosurgery Clinic
Center for Health & Healing Building 1, eighth floor
3303 S. Bond Ave.
Portland, OR 97239
Map and directions
Read about Jean Henderson, the first tremor patient treated with focused ultrasound at OHSU. She and her husband celebrated with sparkling cider, and she held her glass steady for the first time in years.