Focused Ultrasound: Revolutionary Treatment for Essential Hand Tremors

Watch How Emory Healthcare Immediately Changed a Patient’s Life for the Better 

Man's hand trembles as he feeds himself.

Mac’s Life With Essential Hand Tremor - Before Treatment

Imagine your hand shakes so badly when you hold a pen that no one can read your writing. Or you try to eat, and the peas fall off your spoon before reaching your mouth. 

Welcome to the world of Duward “Mac” MacDonald—and many others like him with essential tremor. This neurological disorder causes Mac’s right hand to shake involuntarily.  

Although Mac has essential tremor, he tries to stay active. At 75, Mac mows grass at the Georgia home where he lives with his wife, Dorothy. But over the last five years, Mac’s tremor got progressively worse. And it affected his quality of life.  

“If you can overcome the tremor, you can get stuff done. But it’s on my mind 24/7,” says Mac. “It frustrates Dorothy to see me struggle. And it’s not fair to her to worry about my problem.”   

Mac went to the neurosurgery team at Emory Healthcare for a life-changing, FDA-approved treatment called high-intensity focused ultrasound.

“We are thrilled to offer this cutting-edge treatment at the Emory Brain Health Center.

Most patients will experience immediate improvement of the shaking caused by essential tremor or Parkinson’s disease.

It’s non-invasive. And there’s no hospital stay.”
- Mac's neurosurgeon

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What Is Focused Ultrasound?

Targeting the Trouble Spot Deep Inside Mac’s Brain

Focused ultrasound can treat certain patients with essential tremor or tremor from Parkinson’s disease that has not improved with medication. Mac will not need incisions in his head and will go home the same day. 

Using magnetic resonance imaging — MRI — to guide them, Mac’s neurosurgeons direct ultrasonic energy onto the precise spot inside the brain responsible for Mac’s tremor.  

According to the neurosurgery team, with high-intensity focused ultrasound, thermal heating is created in a specific part of the brain called the ventral intermediate nucleus of the thalamus, which is causing Mac's tremor. Focused ultrasound destroys the spot in Mac’s brain causing the tremor.

A healthcare professional talks to a patient who is about to enter an MRI machine.

Mac's team uses magnetic resonance imaging — MRI — to guide the process.

Mac's team uses magnetic resonance imaging — MRI — to guide the process.

An illustration of the thalamus inside the brain.

The thalamus, the part of the brain responsible for Mac's tremor.

The thalamus, the part of the brain responsible for Mac's tremor.

How Focused Ultrasound Benefits Patients:

  • Patient doesn't undergo open surgery, incisions, or sedation.
  • Treatment uses ultrasound energy, so there's no exposure to radiation.
  • There's no overnight hospital stay.
  • The potential exists for immediate, significant tremor reduction.

As with any treatment, results vary. Some patients do not improve. Some see initial improvement, but the tremor returns within a number of months or years. For others, the results are immediate and dramatic. 

Mac's Focused Ultrasound Procedure

At a Glance

Behind the Scenes Prep—Inside the Motion Analysis Lab

Mac goes to the Motion Analysis Lab at Emory Healthcare a week before his procedure. The brain health team attaches 60 small, reflective markers to Mac’s hands, arms and around his body. The markers will help their special cameras see and precisely measure his shaking movements. Next, Mac performs a series of exercises—extends his arm and hand in front of him, points with his finger, moves his extended arm in a big circle, and walks across the room. After the treatment, they’ll use these baseline measurements to assess Mac’s shaking.

Arriving at the Brain Center on Treatment Day

Mac and his wife Dorothy arrive very early at the Emory Brain Health Center. Emory Healthcare is the first healthcare system in Georgia to perform focused ultrasound for tremor. And Mac is the center of attention.

Mac and Dorothy arrive at the Emory Brain Health Center.

Mac and Dorothy arrive at the Emory Brain Health Center.

Mac gets a haircut from the team.

Mac gets a haircut from the team.

Mac Gets Prepped for the Procedure

First, Mac’s care team carefully shaves his head. Mac gets approval from his wife Dorothy and a quick kiss on the cheek before heading back with his care team.

Mac gets fitted with a helmet and goes into the MRI.

Mac gets fitted with a helmet and goes into the MRI.

Doctors Fit a Special Frame and Helmet Around Mac’s Head 

Next, Mac performs another baseline neurological exam, tracing a spiral and drawing a straight line on a piece of paper. Then they fit a frame around Mac’s head to keep it in position during the procedure and lead him to the MRI lab. A team of neurosurgeons, neurologists, radiologists and physiologists will keep him comfortable and monitor him during the procedure. Representatives of Insightec, the company that created the focused ultrasound system, also attend. 

The care team positions a special helmet over the frame and fills it with water. The helmet contains electronic devices, called transducers, that will send soundwaves to a precise spot in Mac’s brain. When Mac enters the MRI scanner, his neurosurgeons can see his brain function during the procedure.

First, the Team Target Mac's Tremor

Sitting in a control room guided by MRI, Mac's nuerosurgeon uses a computer mouse to expertly deliver more than 1000 ultrasound beams into Mac’s brain. The ultrasound generates heat, called an ablation, that destroys the part of the brain that causes Mac’s tremor. First, the surgeon performs a small test to assess the results and then repeats the procedure. 

Performing surgery without a scalpel—Non-invasive focused ultrasound.

Performing surgery without a scalpel—Non-invasive focused ultrasound.

Mac's Care Team Takes a First Look at the Results 

To check the procedure’s impact on Mac’s tremor, the team joins Mac in the MRI room and conduct the neurological exam again. They ask Mac to use a pen and draw on a clipboard. Mac shows immediate improvement; his hand barely shakes.   

“Oh, my God, it’s amazing,” says Dorothy when doctors show her the results. “It absolutely makes me tear up because he struggled for so very long.” 

Mac’s wife marvels at the immediate improvement in his essential tremor.

Mac’s wife marvels at the immediate improvement in his essential tremor.

A Final Ablation and Dramatic Results 

What Focused Ultrasound Did for Mac’s Tremor

To complete Mac’s focused ultrasound treatment, his neurology team performs a final ablation to destroy the part of the brain causing his tremor. Afterward, they ask Mac to raise his hand and try to use his pen again. The results are dramatic.  

 Mac’s hand does not shake; he can now draw straight lines and even sign his name.  

 “I haven’t been able to do that in years,” says Mac. “It feels great.” 

Look to the Future 

Now, Emory researchers will explore how they can use focused ultrasound to help patients with other brain issues, including tumors, Alzheimer’s disease, epilepsy and psychiatric disorders.

Who Is a Good Candidate for High-Intensity Focused Ultrasound?  

The FDA has approved high-intensity focused ultrasound for people who meet specific criteria, including:  

  • Patients with diagnosed essential tremor (and who are at least age 22)
  • Patients with tremors caused by Parkinson’s disease (and who are at least age 30)
  • Patients with a diagnosed tremor that does not lessen with medication

You don’t have to live with shaking hands. The expert neurologists and neurosurgeons at Emory will help determine if you are a good candidate for focused ultrasound.

For more information, or to refer your patient, please call: 404-778-3444.

Watch the Full Documentary — Focused Ultrasound for Tremor at Emory Healthcare 

“Your Fantastic Mind” highlights this revolutionary, noninvasive treatment for people with essential tremor or tremor from Parkinson’s disease.

“Your Fantastic Mind” is a television series created through a partnership between Emory University and Georgia Public Broadcasting, with support provided by Southern Company Charitable Foundation.