High-Intensity Focused Ultrasound (HIFU) for Movement Disorders

HIFU is also known as focused ultrasound (FUS) or MRI-guided focused ultrasound (MRgFUS). Like standard ultrasound imaging, HIFU relies on high-frequency sound waves that easily pass through your body. During a HIFU procedure, doctors carefully focus over a thousand sound waves to heat and damage small areas of the brain (about the size of a pea). This interrupts the brain signals that cause tremors.

HIFU is also used to treat certain types of cancers, including prostate cancer, primary brain cancer, and metastatic brain cancer.

Benefits
HIFU reduces severe tremors by about 70%. Compared with alternatives like deep brain stimulation, the risk of bleeding and other complications is low. The outpatient procedure is quick, and results are immediate. Studies show the effects of HIFU last for three to five years.

Risks
You may experience instability and imbalance while walking that can last for several weeks or, in rare cases, a few months or longer. Other side effects like numbness, tingling, headaches, trouble speaking, or changes in taste are usually mild and often resolve within a month.

A movement disorder specialist will determine whether you are a candidate for HIFU.

Phone Call
A Duke provider will talk with you on the phone to learn more about you and your tremors.

In-Person Visit
During a clinic appointment, a movement disorder specialist will review your medical history and ask about when your tremors began, what areas of your body are affected, and what treatments you’ve tried. You will undergo a thorough tremor assessment, using your hands to write your name, pour water, and complete other tasks. You will also undergo a neurological assessment to test your strength and sensation. Your doctor will also record a video of your tremors. That same day, you will undergo a CT scan to determine the density of your skull, which is key to whether you are a HIFU candidate.

Preparing for HIFU
Before your procedure, you will:

• Meet with the neurosurgeon who will perform your HIFU procedure.
• Start a physical therapy regimen to combat instability after the procedure.
• Undergo a special type of MRI to map your brain and guide therapy on treatment day.

On the day of your HIFU procedure, your head will be shaved to maximize accuracy of the ultrasound beams.

Four spots on your scalp will be numbed so a special frame can be fitted to your head to keep it still throughout the procedure. A helmet-like device filled with cold water to cool your scalp and help conduct the ultrasound waves will be secured to the frame.

Doctors will use MRI images to visualize your target areas. Then your doctor will apply a low dose of focused ultrasound to fine-tune the target. You might feel some pressure in your head, or your scalp may feel hot. Your doctors may ask you to draw or write to measure your progress.

Once your doctors zero in on the final target areas, the full dose of focused ultrasound energy is applied to each spot for around 30 seconds. You will repeat drawing and writing samples to test whether the treatment was successful.

Finally, the head frame is removed, and you will be observed for about an hour before you go home.

Our Experience Means Better Results
Studies show that major medical centers like Duke, with experts who have performed scores of these procedures, achieve better results, including fewer complications and better outcomes.

We Take Complex Cases
Duke has the expertise to treat people who have been turned away at other centers. This includes people with pacemakers and similar implanted devices, which can be put into an “MRI-safe mode” during the HIFU procedure while a team closely monitors your heart function. Other centers may not have the necessary technology or experience to facilitate these MRI scans.

Team Approach to Care
As a Duke patient, your care team includes experts who work together to deliver the best care. In addition to specially trained neurologists, neurosurgeons, radiologists, physician assistants, and nurse practitioners, our team includes physical and occupational therapists, imaging technologists, and nurses who help manage your care and recovery.

Patient Coordinator 
A patient coordinator will help you schedule appointments, coordinate visits, and plan your procedure. They guide you through every step of the process. They are more than willing to answer your questions along the way.

Ongoing Clinical Research
Duke researchers are working to create best practices for HIFU therapy, improve HIFU technology, and adapt HIFU to treat other conditions.