Step-by-Step Procedure of MR-Guided Focused Ultrasound What Patients Should Expect

Step-by-Step Procedure of MR-Guided Focused Ultrasound What Patients Should Expect

MR-Guided Focused Ultrasound MRgFUS is fast becoming the preferred treatment method for patients with movement disorders like Essential Tremor and the Tremor component of Parkinson’s Disease. Patients often prefer the non-invasive method because there is no need for a scalpel, no sutures, and no devices that remain embedded in the brain.

Brain surgery can be daunting for patients and families. Questions on the safety of the procedure and on preparation and recovery are common. What patients most want to be aware of is what the procedure itself entails. Knowing some details about the method can help patients overcome their neuroses that are a by product of their perception of the surgery.

This guide details the workings behind MR-Guided Focused Ultrasound, the criteria for its deployment, the diagnostic methods and the expectations of the patient for the procedure itself in the pre-op, intra-op and post-op phases.

How does MR-Guided Focused Ultrasound work?

The aim of MR-Guided Focused Ultrasound is the use of therasound waves, which are targeted and focused physically to a small region of the brain that causes the symptoms responsible for the patient’s tremors and movement disorders. Advances in the imaging of the brain by MRI make for real-time guidance of the treatment, which helps with the accurate focus by the physician on the affected area without collateral damage to the surrounding areas of the brain.

The treatment is used primarily for:

• Essential Tremor
• Parkinson’s Disease Tremors
• Tremor-Dominant Parkinsonism
• Certain Neurological Movement Disorders
• Selected Chronic Pain Syndromes

Without the need for a surgical incision, patients can expect a relatively quick recovery.

When Patients with Tremors Become Candidates for MRgFUS

While there is a range of relief that chronic medicine can provide, patients with tremors that become detrimental to the fulfilment of the activities of daily living and who find that the common forms of medication provide no further relief become candidates for MR-Guided Focused Surgery.

Key Symptoms of Essential Tremor

• tremors of the hand
• problematic writing
• hand tremors while holding objects
• voice tremors
• tremors in the head, neck, and jaw

Key Symptoms of Parkinson’s Tremors

• resting tremors
• rigid muscles
• slowed body movements
• altered walking and loss of balance
• decreased facial expressions

If symptoms worsen even with medication, neurologists can suggest treatments such as MRgFUS.

Diagnosis and Evaluation

Before the procedure, several evaluations are conducted to determine if the patient is eligible for the treatment.

Neurological Evaluation

A physician specializing in neurology can determine:

• tremor severity
• movement challenges
• balance, coordination, and timing
• the effect of medication
• other pertinent factors

MRI

Mapping the brain with MRI guides a physician as to which part will be the focus during treatment.

CT Skull Scan

This procedure is a requirement since:

• Skull structures affect treatment success
• Ultrasound waves need to successfully pass through the skull

General Medical Assessment

Physicians assess the overall health to see if a patient is eligible for MRgFUS.

Step-By-Step Procedure of MR-Guided Focused Ultrasound

Step 1: Pre-Procedure

A patient’s scalp is completely shaved. Ultrasound waves pass through the scalp better.

To stabilize and guide the focus throughout the procedure, a patient’s head is put under a special frame.

Continuous feedback of the patient’s symptom improvement is the reason a patient stays awake for the entire treatment.

Step 2: Positioning Inside the MRI Machine

The patient lies inside the MRI scanner with their specialized treatment helmet linked to the Focused Ultrasound system.

As an ultrasound treatment is being dispensed, the scalp is cooled with coils of circulating cold water.

Treatment begins with the patient being assured of their comfort.

Step 3: Brain Mapping and Treatment Planning

MRI imaging is used by doctors to analyse which elements of the brain are involved in the generation of the tremors.

Initially, low-energy ultrasound waves are released to test the targeting. At this time, patients may be asked to do the following:

• Take a specific action with their hands
• Engage in scratch paper activities
• Hold things
• Complete simple movement tasks

The medical team is confirming the area of treatment.

Step 4: Focused Ultrasound Energy Delivery

There is an increase in ultrasound energy as the area of targeting is confirmed.

The ultrasound waves now cause a mechanical disruption of the brain tissue.

The brain waves causing the tremors are stabilized to control.

During this phase:

• The brain is kept cool
• Doctors observe the patient to see if tremors are lessening
• Patients are kept awake and informed of what’s taking place

Many patients note that they are experiencing fewer tremors during treatment.

Step 5: Continuous Monitoring During Treatment

During the treatment, several things are being monitored by the medical team.

These things are:

• Changes in the patient’s speech
• The patient’s balance
• Any tingling sensations
• Control of the patient’s tremor
• Any temporary side effects of the treatment

The treatment may be lengthy, as it is patient-specific, and the case being addressed is complex.

Step 6: Observation After the Procedure

Once the treatment is finalized, the patient is taken to a recovery space for continued assessment.

Things to be monitored are:

• Blood pressure
• Neurological state
• Ability to walk
• General recovery

The majority of treatment patients are able to walk soon. There is a possibility of imbalance or exhaustion.

Recovery After MR-Guided Focused Ultrasound

Recovery is expected to be quicker than for brain surgery.

Recovery from the procedure can come with side effects like:

• Headache
• Tingling
• Balance issues
• Nausea or dizziness
• Fatigue

Recovery time is different for every patient, but typically, patients can be back to regular activities after a few days.

Check up visits are very valuable to assess the procedure’s effects.

Benefits of MR-Guided Focused Ultrasound

The procedure can have many benefits, such as:

• No cuts or stitches
• Reduced chance of infection
• Shorter recovery
• A faster-than-normal expected hospital stay
• No implanted devices
• Reduction of tremors for certain patients

Many patients can be treated, but selecting suitable patients for treatment is of paramount importance.

Conclusion

Non-surgical options for treatment of movement disorders are scarce, but for some patients, MR-Guided Focused Ultrasound is an excellent option. This procedure offers the patient advanced precision imaging to treat tremors non-invasively.

Due to the many aspects of the procedure, having some understanding can help a nervous patient feel more prepared. From the initial diagnosis to recovery, careful consideration is taken to ensure results are effective and safe.

For help with symptoms of movement or speech disorders, patients should contact their neurologist and inquire if MR-Guided Focused Ultrasound is a treatment option for them.

Frequently Asked Questions

1. Is MR-Guided Focused Ultrasound surgical?
No. MR-Guided Focused Ultrasound MRgFUS does not require any incisions of any kind.

2. How long does MR-Guided Focused Ultrasound take?
The entire MRgFUS procedure can take a few hours, so the staff have time to prepare and conduct post-procedure monitoring.

3. Are patients monitored while they are awake?
Most commonly, yes. MR-Guided Focused Ultrasound requires patients to be awake to achieve both monitoring and improvement of the symptoms being treated.