MR-guided focused ultrasound for essential tremor

Thanks to a grant from Imperial College Healthcare Charity, the Trust was able to acquire specialist equipment to trial magnetic resonance-guided focused ultrasound to treat essential tremor.

About the technology

Magnetic resonance-guided focused ultrasound (MRgFUS) technology uses MRI imaging to guide high powered, focused ultrasound to a very small point. At that point, molecules are vibrated extremely quickly, which creates intense local heat. That heat can “cook” tissue and destroy it. MRgFUS allows clinicians to target a very specific focal point – with very little heating produced in front of and behind that point, so only the targeted tissue is affected.

The technology is currently used to treat conditions such as uterine fibroids and at the Trust, we are currently trialling its use in the treatment of low grade prostate cancer.

MRgFUS for essential tremor

Essential tremor is a shake of a part of the body that cannot be controlled. There are many causes of severe tremor – it is a syndrome rather than a specific condition. There are over one million people with essential tremor in Britain and around 250,000 people with the syndrome are severely disabled by their tremor. Current treatments include drug therapies, surgery and deep brain stimulation. These treatments are of limited effectiveness or cannot be used in all sufferers, and some have moderate risks and side effects.

However, clinical researchers have recently developed a technique that allows MRgFUS to be used in the brain to treat essential tremor. There is a growing body of clinical evidence from around the world that this procedure is safe and effective, and it has been shown recently to have very successful outcomes in the treatment of essential tremor, with many fewer risks.

Thanks to a grant from Imperial College Healthcare Charity, the Trust was able to acquire specialist equipment to trial MRgFUS to treat essential tremor. Led by consultant radiologist Professor Wladyslaw Gedroyc, reader and honorary consultant neurologist Dr Peter Bain and consultant neurosurgeon Mr D Nandi, we are currently trialling this procedure with a small number of patients who have essential tremor. Results have been very promising thus far. This is part of a multinational study so there have already been publications on essential tremor from other researchers that have also explored this technology, but we are the first site in the UK to use this technology to treat essential tremor.

The trial is now closed. If you want to learn more about the trial, please contact Dr Peter Bain’s office. If you believe you may be a candidate for this treatment, you are welcome ask your GP to refer you to Dr Bain’s movement disorders clinic at the Charing Cross Hospital neurology outpatients.

Next steps

The first trial in essential tremor is expected to be completed by summer 2017, and it will likely be a further six months before a research paper is published in a peer-reviewed journal. The Trust anticipates that this research will form a key part of NICE’s and NHS England’s consideration on whether or not to fund this new procedure for all suitable NHS patients in England.

In the coming year, researchers at the Trust will also explore ways of treating patients with Parkinson’s disease using this technique.

Future applications

There are potentially many other ways MRgFUS can be utilised in the brain – essential tremor is just the first of a substantial amount of applications that will evolve. Future applications may include conditions such as tumours, epilepsy and perhaps dementia. All of these will be areas of research and development in the coming years.