High-intensity focused ultrasound (HIFU) offers a next-generation incisionless outpatient procedure for patients with essential tremor who don’t get acceptable tremor relief from medications. Experts at Baptist Health Brain & Spine Care have experience in delivering this leading-edge treatment.

Abnormal electrical activity deep in your brain causes essential tremor. HIFU therapy uses image-guided ultrasound to deliver ultrasound energy (sound waves) to the area of your brain where this abnormal electrical activity is happening. The ultrasound energy destroys the cells causing the abnormal electrical activity.

During HIFU you will be inside an MRI scanner. This lets your doctor target the exact area in your brain with abnormal electrical activity.

After HIFU treatment, you should feel your tremor symptoms subside immediately. HIFU is a noninvasive treatment that allows you to recover quickly and return to your normal activities. The U.S. Food and Drug Administration (FDA) has approved HIFU to treat tremor on both sides of your body.

Benefits of HIFU Treatment

Incisionless Treatments

  • Little to no risk of infection
  • Minimal or no hospitalization
  • No general anesthesia required
  • No invasive burr holes or implants

Immediate and Significant Results

  • Immediate tremor improvement post-procedure
  • Improved quality of life
  • Tremor stably maintained at three years

Side Effects of HIFU Treatment

Some side effects are possible after HIFU treatment. You may experience:

  • Balance problems
  • Difficulty with speech and swallowing
  • Headaches
  • Nausea
  • Numbness
HIFU Results You Can See

HIFU Results You Can See

In real-time, we confirm the tremor is getting better. We talk with you to make sure you’re comfortable, and we take more pictures using MRI. We may ask you to move in certain ways or to write or draw to see how your tremor responds.

Are you a candidate for HIFU treatment?

  • Do you have a family history of tremor?
  • Does your tremor get worse with activity and better when you're at rest?
  • Does your tremor improve with alcohol?

If you answered yes to one or more of these questions or previously received HIFU treatment for your tremor on your dominant hand, you may be a candidate for this procedure.

HIFU is now approved by the FDA to be performed on both sides of the brain. If you received HIFU treatment for one side of your body, you may now be eligible for complete tremor relief.

Photo of Roberto Rodriguez
"First of all, I would say thank you and I’d like to encourage people that might be suffering from this situation — please go check it out,” says Mr. Rodriguez. “It’s not painful at all. And, believe me, you’re going to know the difference — it’s like you’re feeling brand new again."

Meet the Team

Timothy Miller, M.D., Neurosurgeon and Director of Functional Neurosurgery at Marcus Neuroscience Institute, and Justin Sporrer, M.D., Neurosurgeon and Director of Functional Neurosurgery at Baptist Health Miami Neuroscience Institute, are leaders in developing new therapies for movement disorders. Backed by neurologists, neuroradiologists, neuropsychologists, social workers and rehabilitation therapists, our experts personalize treatments to your conditions and needs.
 

Justin Matthew Sporrer, M.D.

Neurosurgeon and Director of Functional Neurosurgery, Baptist Health Miami Neuroscience Institute

 

Timothy Miller, M.D.

Neurosurgeon and Director of Functional Neurosurgery, Marcus Neuroscience Institute

 

Frequently Asked Questions

 

About HIFU

  • Focused ultrasound is an incisionless treatment for essential tremor patients who have not responded to medications. It is based on MRI-guided focused ultrasound (MRgFUS) technology. Our providers use MR imaging to guide sound waves so they can treat precise spots deep in the brain.

    Unlike a diagnostic ultrasound that uses low-energy waves to capture pictures, focused ultrasound uses high-energy waves for treatment.

  • The FDA approved HIFU for treating essential tremor at the end of 2016 and for treating a patient’s second side essential tremor in 2022.

  • The limitation is based on the FDA approval. The FDA based its decision on the results and criteria of a clinical study.

  • The treatment is FDA approved to treat hand tremor.

  • The treatment is FDA approved for staged unilateral treatment — treating one side at a time with at least nine months between treatments. It is approved for eligible patients who experience no significant clinical events from the first treatment.

  • The ultrasound waves pass through the rest of the brain, but they only come together in the thalamus. Consequently, the temperature increase needed to create a lesion that disrupts the cause of your tremor only occurs in that spot.

  • It’s possible, but rare. MR imaging allows the treating physician to continuously see the treatment area and monitor the temperatures.

Before Your Procedure

  • To be a candidate for the incisionless treatment, you must be diagnosed with essential tremor that either doesn’t respond to medication or isn’t eligible for at least two standard-of-care medications. Please discuss with your physician.

  • Yes, you need to have a definitive diagnosis of essential tremor. Your healthcare provider, primary care physician, a neurologist or a movement disorder specialist can provide this diagnosis. See other criteria below and discuss with your physician. Call us to schedule an appointment with one of our specialists.

  • Yes, you will need to get a specialized CT scan. Some treatment centers may ask you to get an MRI scan as well.

  • Everyone’s skull is different. Your specialist will complete a CT scan to determine if the shape and thickness of your skull are suitable for the incisionless treatment. Certain skull shapes and thickness may make it impossible for ultrasound waves to reach the temperature at the target required for treatment.

  • Typically, you’ll meet with your treating physician at least two times. At the first consultation, the physician will evaluate your CT scans to determine whether you are a candidate for the treatment. The second time is on treatment day.

    In some instances, you may meet a third time for follow-up imaging on the day after treatment. The treating team will also discuss any additional follow-up visits needed, as well as information that will be relayed back to your referring physician.

  • This is necessary for two reasons:

    • Ultrasound waves do not travel well through hair. In this treatment, water is used (like a gel used when having an abdominal ultrasound) as a conductive medium. The smooth-shaven scalp and a silicone cap enable a tight interface with the ultrasound transducer.
    • Air bubbles could get trapped in the hair, blocking the ultrasound waves and absorbing energy which could potentially lead to skin burns.

During Your Procedure

  • The frame is a standard stereotactic frame that helps ensure your head does not move during the treatment.

  • No, you will be inside the scanner from about your mid-torso up.

  • No, the treatment bed will move in and out of the MRI scanner. After each application of energy, your tremor will be assessed by doing various tasks, such as drawing a spiral.

  • Your feedback during the treatment is necessary as you will be asked to do different neurological tasks, such as drawing spirals. This is so the physician can evaluate the improvement of your tremor. They can also identify and address any potential side effects that you may be experiencing during the treatment.

  • The treatment time is on average two-and-a-half hours. Most people undergo the treatment on an outpatient basis. Your treating physician will decide when you can return home.

  • The most recent data shows hand tremor improvement of the study subjects was mostly maintained at three years*. Everyone’s experience is different. Your tremor may return after months or years. Or your tremor may not improve at all. It’s also important to understand that this treatment is only intended to improve your tremor. It does not treat your underlying disease or stop its progression.

    *Pre-Market Approval (PMA) P150038 https://www.accessdata.fda.gov

After Your Procedure

  • That depends on the type of work that you do and how you feel. Please consult with your physician.

  • The treatment team will provide you with instructions related to your post-treatment recovery.

  • If your first treatment was at least nine months ago, you may be eligible to have the second side treated. Contraindications for treating the second side after initial HIFU treatment include:

    • Abnormal speech function
    • Difficulty swallowing (dysphagia)
    • Gait abnormalities (moderate-to-severe)
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"This is a praise. This is a high five. This is everything. Just be brave enough to say, ‘Yes, I’ll do it,’ and go forward. And you will never regret it, never."

Our Locations

  • Brain & Spine Care | Kendall (Suite 407W)
    Opens at 8 a.m.

    Brain & Spine Care | Kendall (Suite 407W)

    8950 N Kendall Drive, Suite 407W Miami, FL 33176
  • Marcus Neuroscience Institute | Boca Raton
    Opens at 8 a.m.

    Marcus Neuroscience Institute | Boca Raton

    800 Meadows Road Boca Raton, FL 33486
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