Focused Ultrasound (MRgFUS)

The doctors supported by Northern Neuroscience offer cutting-edge Focused Ultrasound (MRgFUS) treatments to provide non-invasive solutions for various neurological conditions. The advanced technology we provide your skilled specialist ensure they can provide precise and effective care to their patients.

What is Focused Ultrasound (MRgFUS)?

Focused Ultrasound (Magnetic Resonance-guided Focused Ultrasound, MRgFUS) is a revolutionary, non-invasive treatment that uses focused ultrasound waves to target and treat specific areas within the body. Guided by MRI, this technique allows for precise targeting without the need for incisions.

Conditions Treated with MRgFUS

MRgFUS can be used to manage and treat a variety of conditions, including:

• Essential tremor
• Parkinson’s disease tremor
• Neuropathic pain
• Bone metastases pain
• Uterine fibroids
• Prostate cancer

This versatile technology offers a promising alternative to traditional surgical methods, reducing recovery time and minimising risks.

How it Works

The MRgFUS system positions the head in the MRI scanner and directs high-frequency ultrasound waves through the scalp. A total of 1024 transducers focus ultrasound energy into a precise area to create a small lesion in the brain region responsible for tremor (Figure 1).

Initially, a reversible test dose is administered to ensure correct targeting and effect. A final dose creates a permanent lesion visible on MRI, interrupting the cerebellothalamocortical pathway responsible for tremor. Currently, treatment is delivered to one side of the brain, with studies on bilateral treatment underway.

Effectiveness

The first randomised trial, published in 2016, led to FDA approval and showed a 65% improvement in disability and a 55% improvement in tremor scores. Subsequent trials reported even greater improvements, with disability improvements up to 80% and tremor score improvements between 65-75% (Figure 2).

The treatment effect is maintained long-term, with four-year data showing a low rate of tremor recurrence. The effect size is comparable to, or better than, traditional surgical approaches.

What to Expect During the Procedure administered by your doctor

1. Initial Consultation:
   • Detailed assessment of your medical history and condition
   • Discussion of the potential benefits, risks, and suitability of MRgFUS for your specific case
   • Personalised treatment planning and preparation guidelines
2. During the Procedure:
   • You will lie on an MRI table, and the target area will be precisely located using MRI guidance
   • Focused ultrasound waves will be directed at the target area to achieve the therapeutic effect
   • The procedure is typically painless, although you may feel some warmth or mild discomfort
   • Most treatments take a few hours and are performed on an outpatient basis
3. After the Procedure:
   • You can usually return to normal activities shortly after the treatment
   • Follow-up appointments will be scheduled to monitor your progress and ensure optimal outcomes
   • The therapeutic effects may be immediate or develop over time, depending on the condition treated

Evaluation:

Patients are first seen by their Neurologist with experience in movement disorders. A definitive diagnosis and certain basic investigations are required prior to selection for the procedure. Patients require CT and MRI brain imaging prior to treatment and may be excluded if found to have low skull density ratio. The latter determines the amount of energy that can be delivered via the system.

The Your Neurologist will explain the procedure in detail and then obtain consent. At present there are only 2 sites with doctors in Australia offering MRgFUS. Dr Ahmad has expertise in this field and can offer this service to Sydney patients.

Cost:

At present, this procedure is not covered by Medicare in Australia. However, given the strong clinical trial data and progress overseas with reimbursement, it is hoped that this will change soon. Various finance options are available to help offset or eliminate affordability issues.

Duration:

A treatment takes on average 3-4 hrs. Planning is undertaken several weeks prior and involves the treatment team agreeing to a target and treatment plan.

Post procedural care:

Following the procedure, patients typically require an overnight hospital stay as a precaution and for observation. Follow-up is made at the 3 month mark at which time tremor assessments are carried out for research purposes.

Your Treating Team:

• Neurologist:Determines the diagnosis and performs tremor evaluation and responses while in the MRI scanner. Responsible for follow up care.
• Neurosurgeon: Positions patient and head in stereotactic frame. Determines the optimal target and performs sonications.
• Radiologist: Operates the MRI scanner and performs specialised MRI sequences for thermal imaging, fusing of images and highlighting vital tracts.

Why We Support Your Doctor

• Expertise: The doctors we support are highly trained in performing MRgFUS, ensuring precise and effective treatments.
• Innovative Technology: The doctors we support utilise the latest in focused ultrasound technology, providing state-of-the-art care.
• Patient-Centred Approach: The doctors we support are committed to delivering personalised care, focusing on the unique needs and preferences of their patients.

Further Information:

• https://fmig.com.au/focusneuro-tremor-treatment
• https://www.fusfoundation.org
• https://www.essentialtremor.net.au/neuravive