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Transcranial MR-guided high intensity focused ultrasound (MRgHIFU) is an outpatient procedure that uses ultrasound waves to disrupt pathways that transmit abnormal electrical signals in the brain. It works by focusing ultrasound waves into discrete brain regions – without opening the skull.
MRgHIFU is Food and Drug Administration (FDA)-approved for the treatment of essential tremor (ET) and Parkinson’s disease. UT Southwestern is the first medical center in Texas to offer transcranial MRgHIFU.
Our high-volume center is a leader in offering MRgHIFU for the treatment of essential tremor and Parkinson’s disease. We provide comprehensive evaluation by a team of neurologists, neuroradiologists, and neurosurgeons to determine if the procedure is appropriate and ensure coordinated, personalized care.
Members of the UT Southwestern team have extensive experience with MRgHIFU and have developed advanced imaging techniques to safely and effectively perform the procedure.
The benefits of MRgHIFU include:
Risks associated with the procedure include:
Alternative treatments include:
MRgHIFU is used to treat a variety of neurological conditions. The FDA has approved its use for:
Transcranial MR-guided focused ultrasound is used to treat a variety of neurological conditions. The FDA has approved its use for:
Transcranial MRgHIFU offers an incisionless, image-guided alternative for treating essential tremor (ET) and Parkinson’s disease (PD).
Jimmy Hiner struggled for decades with a tremor in his right hand that affected his ability to function. After being diagnosed by experts at the O'Donnell Brain Institute, he became the first patient in Texas to undergo a procedure called high-intensity focused ultrasound (HIFU), which uses MRI-guided ultrasound waves to precisely target an area in the brain linked to Parkinson’s disease and essential tremor.
Patients are evaluated for MRgHIFU – whether for essential tremor or Parkinson’s disease – by a team that includes neurologists, neuroradiologists, and neurosurgeons, with input from neuropsychologists and other specialists as needed.
The evaluation begins with a comprehensive medical history and neurological exam to confirm the diagnosis and assess treatment suitability. Because other therapies may be appropriate – including medications or deep brain stimulation – the team reviews all options to determine the best approach for each patient, considering the risks and benefits of each approach and the patient’s preference. If MRgHIFU is recommended, patients then meet with a UT Southwestern expert in the procedure.
We review the patient’s medical records with them. The patient then has a computed tomography (CT) scan of their head to determine their skull density ratio (SDR), which will determine whether the patient is a candidate for the procedure.
The patient also receives a special advanced brain magnetic resonance image (MRI) scan that allows us to map the brain.
After a brief neurologic exam, the patient is taken to the Neuro MRgHIFU suite at William P. Clements Jr. University Hospital (CUH). A plastic frame is attached to the patient’s head to prevent motion during the procedure. The patient is then placed in the MRI scanner for treatment.
During the treatment, the patient may experience nausea or have a falling sensation. Antinausea medicine is given prior to the procedure to help alleviate these feelings. The patient spends 45-60 minutes in the MRI scanner for the treatment and is evaluated after each ultrasound therapy has been delivered, to ensure that the tremor is improving and side effects are not occurring.
Once the target is confirmed, higher-energy ultrasound waves are delivered. When this part of the process is finished, the procedure is complete, and the head frame is removed.
A follow-up MRI exam is performed, and then the patient is taken to a recovery area for two hours. After recovery, the patient is discharged from the hospital with instructions to follow up with the doctor in one to two days.
In the initial hours following the procedure, the patient might experience a mild headache. Because there are no incisions or anesthesia, there is no prolonged recovery period, but we recommend that the patient take it easy for the next two weeks.
The patient should follow up with the referring neurologist for ongoing management and medication adjustment, if needed. If the tremor recurs or is still functionally disabling following MRgHIFU, the patient might be a candidate to consider another round of treatment with the same technology or with deep brain stimulation therapy.
We are pursuing research into using MRgHIFU to help deliver drug therapies and diagnostic agents into the brain – past the blood-brain barrier, an immunological defense that prevents material in the blood from entering the brain. The research is part of our investigative studies into the diagnosis and treatment of neurodegenerative diseases such as Alzheimer’s disease, brain tumors, and other diseases of the brain.
Peter O'Donnell Jr. Brain Institute
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