Focused Ultrasound (MRgFUS)

MRI-Guided High-Frequency Focused Ultrasound (MRgFUS) is a noninvasive, FDA-approved procedure that uses focused sound waves and real-time MRI guidance to treat the area of the brain responsible for essential tremor. Unlike traditional surgery, there are no incisions, implants, or general anesthesia involved, and patients remain awake and communicating with our team throughout the procedure.

During treatment, the MRI serves as the “eyes” of the procedure, allowing our team to plan, guide, and confirm treatment delivery with sub-millimeter precision in real time. Approved by the FDA in 2016 for medication-refractory essential tremor, Goodman Campbell offers MRgFUS through our functional neurosurgery program at Ascension St. Vincent in Indianapolis.

You may be a candidate for focused ultrasound if you have a movement disorder, such as essential tremor, that continues to interfere with your daily activities despite medication. Focused ultrasound is generally considered for patients whose tremor has not responded adequately to medications or who cannot tolerate medication side effects. The goal of the procedure is to create a small lesion in the area of the brain responsible for tremor using precisely focused ultrasound energy.

Focused ultrasound is an incisionless treatment that does not require implanted hardware, making it an option for patients who prefer to avoid implants or who may not be candidates for implant-based surgery. Unlike deep brain stimulation (DBS), focused ultrasound is typically performed on one side of the brain at a time. For patients who may benefit from treatment on both sides, a second procedure may be considered after recovery and follow-up, commonly nine months or more after the initial treatment.

You should ask your doctor about your specific condition and whether focused ultrasound is the right treatment option for you.

Focused ultrasound essential tremor treatment works by directing more than 1,000 ultrasound beams toward a precise area in the thalamus called the Vim nucleus, which plays a key role in tremor activity. The focused energy creates a small, targeted lesion that interrupts the abnormal brain signals that cause uncontrollable shaking. Because the ultrasound passes safely through the skull and surrounding tissue, healthy areas of the brain are preserved, and many patients notice immediate tremor improvement during the procedure itself.

Before your procedure, you will undergo a high-resolution MRI and other testing to determine whether focused ultrasound is appropriate for you and to help identify the exact area of the brain that will be treated.

On the day of your procedure, your head will be shaved to allow the ultrasound energy to pass through the scalp efficiently. Your head will be secured in a specialized frame as you lie inside an MRI scanner. Throughout the procedure, you will remain awake so your care team can monitor your tremor and ask for feedback. Focused ultrasound energy is delivered through the skull without making an incision, while the MRI allows your surgeon to precisely target the treatment area.

After the procedure, you will spend a short period in recovery for observation. Most patients go home the same day. You should ask your doctor about what to expect following your specific procedure.

With any procedure, there are risks you should talk to your doctor about. Some common side effects include headache, dizziness, nausea, temporary numbness or tingling, balance difficulties, or weakness. Although many of these side effects improve over time, some may persist.

Most side effects associated with focused ultrasound thalamotomy are temporary and may include dizziness, headache, nausea, and a feeling of unsteadiness. These side effects typically resolve within hours to days. Similarly, numbness or tingling in the hands or face, or mild gait irregularities might also be experienced, and usually resolve within 30 days. Real-time MRI guidance allows our team to continuously monitor brain temperature and treatment accuracy throughout the procedure, helping protect surrounding healthy tissue. As with any brain procedure, there are risks involved, and our functional neurosurgeon, Mark Hoeprich, MD, will carefully review your individual risk profile before moving forward.

Because focused ultrasound creates a permanent lesion in the brain, the effects of treatment cannot be reversed. Your doctor will discuss the potential risks and benefits based on your individual condition.

Candidates for focused ultrasound thalamotomy are typically adults 22 or older with essential tremor or tremor-dominant Parkinson’s disease whose symptoms continue to interfere with daily life. The average treatment time for focused ultrasound is approximately 2.5 hours, and patients will be moved in and out of the MRI scanner as needed to complete various tasks, such as drawing a spiral. A preliminary CT scan is used to evaluate skull density and geometry, since not every patient’s anatomy allows ultrasound waves to effectively reach the target. Certain MRI-incompatible metal implants, severe claustrophobia, or other cardiac/systemic health conditions may affect candidacy, which is why our neurosurgeons carefully review every patient’s history before recommending treatment.

Your treatment team is experienced and will provide excellent care throughout the process. Before your procedure, you will be asked to answer questions about your medical history and may undergo additional testing to confirm that focused ultrasound is the right treatment for you.

You should follow all provided instructions before your procedure. Your physician will review your medications and let you know if any should be temporarily stopped before treatment. Because most patients return home the same day, you should arrange for someone to drive you home after your procedure.

On the day of your MRgFUS treatment, your head will be shaved and secured safely in a stereotactic frame that helps us precisely target the treatment area, with the entire procedure lasting approximately 2-3 hours. You will remain awake inside the MRI scanner while our team gradually delivers increasing amounts of focused ultrasound energy and monitors your tremor response in real time. During the procedure, we may ask you to complete simple tasks, such as tracing images or touching your finger, so we can confirm improvement and make adjustments as needed. Most patients return home the same day, although mild unsteadiness afterward is common and usually temporary.

Deep brain stimulation, or DBS, involves surgically placing electrodes in the brain and a pulse generator beneath the collarbone, requiring surgery, general anesthesia, a hospital stay, and ongoing programming and management. MRI-guided focused ultrasound, by comparison, requires no incisions, implants, or anesthesia, and is completed in a single outpatient visit with no hardware to maintain or replace. DBS is adjustable and reversible, while MRgFUS creates a permanent lesion, meaning the effects are immediate but cannot be undone. Because the functional neurosurgeon at Goodman Campbell performs both procedures, our highly specialized team can help patients weigh each option based on their tremor pattern, health status, lifestyle, and personal goals.

Our experienced essential tremor neurosurgeon team in Indianapolis has completed highly specialized training focused specifically on the brain, spine, and nervous system. We perform both MRgFUS and DBS, and help patients determine if and which option best fits their goals, health history, and lifestyle.

Clinical studies have shown that patients undergoing noninvasive tremor treatment with MRgFUS have experienced sustained, reduced tremor, and improved quality was mostly maintained at 5 years. Results are often immediate, and many patients experience meaningful improvements in hand tremor even before leaving the MRI suite. The procedure treats one side of the brain at a time, though some patients may qualify for treatment on the second side after a minimum of 9 months. While this procedure is not considered a cure, it is designed to address the root neurological source of tremor rather than temporarily managing symptoms, and the improvement in daily function (e.g., writing, eating, and dressing independently) is meaningful and lasting for most patients.

Your healthcare provider will give you specific instructions before leaving the treatment center. In general, you should rest for the remainder of the day and gradually return to your normal activities as tolerated. Follow any medication or activity instructions provided by your physician.

Contact your doctor’s office if you experience worsening neurological symptoms or have concerns during your recovery. Most patients recover quickly and can resume their usual daily activities within a few days.

Essential tremor treatment without surgery is covered by Medicare Part B in all 50 states, and many private insurance providers (including Aetna, CIGNA, and Anthem) also cover the procedure for eligible patients. Coverage for tremor-dominant Parkinson’s disease continues to expand across insurance plans as well. Our team can help guide you through insurance verification and answer questions about coverage during your consultation. We also encourage patients to contact their insurance provider directly using CPT code 0398T and ask whether MRgFUS for essential tremor is a covered outpatient benefit under their plan. 

You may experience mild headache, fatigue, dizziness, or temporary balance changes following your procedure. Some patients also notice temporary numbness or tingling. These symptoms are often temporary and improve over time.

Many patients notice improvement in their tremor during or shortly after the procedure, although results vary from person to person. Your physician will schedule follow-up appointments to monitor your recovery and discuss any additional treatment recommendations if needed.

The first step is meeting with functional neurosurgeon Mark Hoeprich, MD, to review your tremor history, prior treatments, and imaging to determine whether you are a candidate. Goodman Campbell is recognized as a leader in neurosurgery, clinical research, and physician training, giving patients throughout Indiana access to a world-class team close to home. Dr. Hoeprich sees patients at Ascension St. Vincent – Indianapolis Functional Neurosurgery.

While a referral from a neurologist or primary care physician can be helpful, it is not always required, and our team is available to guide you through every step of the process. Patients can request an appointment with Dr. Hoeprich by calling 317-338-9660.