Will the tremor return afterwards and how long will the beneficial effects of MR-guided focused ultrasound last? Although, these symptoms, should they occur, usually resolve within a few months there is the possibility that one or more of these adverse effects might remain permanently. The main adverse effects of MRgFUS are caused by cerebral oedema (temporary swelling around the target site in the brain), which may lead to worsening of speech and walking and also numbness, involuntary movements or weakness on the treated side of the body (including face, arm and leg). As it is done in an MRI scanner whilst the patient is awake it may not be possible in patients with claustrophobia (fear of enclosed spaces). The frame is required to prevent the head from moving during the procedure. There can be some intrusive pain and discomfort from the pins that hold the frame to the patients head. The MR-guided Focused Ultrasound procedure is performed with the patient awake and can be somewhat of an ordeal patients often reporting a feeling of dizziness or pressure around the head which may occur several times during ‘sonications’ and lasts for 10-15 seconds on each occasion. In addition if the patient has other serious medical conditions it may be unwise to undergo MR-guided Focused Ultrasound. Generally patients with significant speech impairments, unsteadiness of gait, moderate cognitive impairments or dementia should not be treated with MR-guided Focused Ultrasound, as these could deteriorate after the procedure. Mary's Hospital, Imperial College NHS trust describes MRgFUS, how it works, who it is for, the key benefits and the considerations of treatment Professor Wladyslaw Gedroyc, consultant Radiologist at St. Watch how MRgFUS works featuring Ian Sharp, who is among the first people in Scotland to be treated with MRgFUS at Ninewells Hospital from the University of Dundee. Since April this year (2021) MRgFUS is available on the NHS in England for the treatment of people with essential tremor, having received a positive guidance from NICE in June 2018. The treatment takes approximately 4 hours and many patients can experience an immediate reduction in their tremor, however, their ability to regain skills such as writing, picking up a cup, using cutlery, doing up buttons and zips, using a phone or computer may take longer to recover. High intensity focused ultrasound is used to destroy one or two small areas of tissue in the brain which are responsible for the tremor. The treatment combines two technologies – high intensity focused ultrasound (FUS), that is guided by Magnetic Resonance (MR) Imaging. MRgFUS, or Magnetic Resonance-guided Focused UltraSound, is a safe, cost effective and incisionless procedure for the treatment of essential tremor. Trials have been shown to deliver similar patient outcomes to Deep Brain Stimulation (DBS), often in an outpatient setting, and NHS England has now determined that this should also be available as an NHS service. MRgFUS, or Magnetic Resonance-guided Focused UltraSound, is an incisionless procedure for the treatment of Essential Tremor
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