MRgFUS in India

Yes, MRgFUS is considered a safe and non-invasive procedure. It is guided by real-time MRI imaging, which allows for precise targeting of the treatment area while minimizing damage to surrounding healthy tissues.

MRgFUS offers several benefits over traditional surgery, including no incisions, reduced risks of complications, shorter recovery times, minimal downtime, and the ability to target specific tissues with precision.

The duration of an MRgFUS procedure varies depending on the condition being treated and the specific treatment plan. However, most MRgFUS treatments are completed in a few hours, and patients can often go home the same day.

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 doctors 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 US FDA had approved this procedure in the year 2016, worldwide more than 12,000 patients are treated with MRgFUS for Essential Tremor and Parkinson’s Disease. In India, in the last 18 months, Royal Care Super Specialty Hospital, Coimbatore, Tamilnadu has treated successfully more than 95 patients.

Magnetic Resonance-guided Focused Ultrasound (MRgFUS) combines two technologies – high intensity focused ultrasound (FUS), that is guided by Magnetic Resonance (MR) Imaging. MRgFUS works by using high intensity focused ultrasound to destroy one or two small areas of tissue in the brain which is responsible for the tremor. Focused ultrasound technology uses ultrasound that pass safely through skin, bone, and muscle. The spot where the ultrasound waves are focussed heats to a temperature of about 55° centigrade which creates a tiny lesion in the targeted area of the brain. The MRI system enables the medical team to identify and target the specific areas to be treated with high precision as well as to monitor the temperature during treatment.

MRgFUS may be a suitable treatment option for patients with moderate to severe Essential Tremor who do not respond to medications or cannot tolerate them. The procedure is also currently approved for Parkinson’s Disease.

A person is awake and fully conscious during the MRgFUS procedure. This is important so that the patient can provide feedback on the improvement of the tremor and any possible side effects that might occur.

The MRgFUS procedure is usually performed in an MRI Scan Unit without general anaesthesia or complete sedation and takes approximately 4-6 hours.

Immediately prior to MRgFUS the patient’s hair is shaved off completely (because hair traps air bubbles, which deflect ultrasound). A frame is then bolted using pins to the patient’s skull under local anaesthetic. During the procedure the patient can report a feeling of dizziness and pressure on the head which may occur several times during the ultrasound pulses (‘sonications’) and lasts for about 10-20 seconds on each occasion. There can be some pain and discomfort from the pins which keep the frame fixed to the head.

The extent of improvement in the tremor in the treated arm varies, depending on the patient’s tolerance of the MRgFUS procedure. The average improvement is about 70-75% but varies from no benefit to almost 100%. This in part depends on the type and severity of the tremor: For example, proximal tremor, which mainly affects the shoulder, is less responsive to MRgFUS than distal tremors that predominantly affect the hand. In addition the density of the patients skull is important, as somewhat surprisingly, the denser the skull the easier it is for the ultrasound to penetrate the skull to reach the target within the brain.

Many patients experience an immediate reduction in their tremor. However, their ability to regain skills such as writing, picking up a cup, using cutlery, doing up buttons and zips, using a phone or computer may take longer to recover.

The non-invasive nature of MRgFUS minimizes the risks of infection or bleeding inside the skull to negligible levels. However, patients with speech impairments, unsteadiness when walking or significant cognitive impairments or dementia would be excluded as these problems could deteriorate after MRgFUS. Furthermore, frail patients or those with significant other co-existent medical problems may need to be excluded because these would increase the risks and diminish the benefits of MRgFUS. The main adverse effects of MRgFUS are caused by cerebral oedema (temporary swelling around the target site in the brain which usually develops in the days after the procedure). This may lead to: 1. Slurred speech 2. Unsteadiness on walking 3. Weakness or numbness on the treated side of the body (including face, arm and leg) 4. Involuntary movements on the treated side of the body (including face, arm and leg) Although, these symptoms, should they occur, usually are temporary and resolve within 3-6 months, there is an extremely rare possibility that one or more of these adverse effects might remain permanently. MRgFUS is an innovative technology, with meaningful published data on patients post five years after MRgFUS treatment, offering great clinical outcomes to patients suffering from Essential Tremors and Parkinson’s disease.

Yes. MRgFUS treatment is available in India from August 2022 at Royal Care Super Specialty Hospital, Coimbatore, Tamilnadu. The hospital can be reached at +91 80623 58663

An assessment of your suitability for therapy will ultimately need to be carried out by the team performing the MRgFUS. However, prior to that you should ask your referring doctor to refer you to a local neurologist for an initial assessment. This should include establishing or confirming the diagnosis of essential tremor or Parkinson’s disease and a discussion about the management of your tremors including possible medical options and MRgFUS. Prior to the appointment with our Royal Care Neurosciences doctors, note down the questions you would like to ask, you may even wish to print and take with you information about MRgFUS from this website. We have uploaded the Frequently asked questions by patients to our doctors on this page https://royalcareneurosciences.com/patient-info/education-material/