How a pioneering procedure can reach the brain without a single cut

Magnetic resonance-guided focused ultrasound technology can be used as a non-invasive alternative to surgery for a number of conditions, and now, a new approach enables clinicians to use this technology to access the brain. In this week’s blog post, consultant radiologist Professor Wladyslaw Gedroyc explains why he advocated bringing the latest MR-guided focused ultrasound technology to Imperial College Healthcare NHS Trust as part of a multinational trial for the treatment of essential tremor.

MR-guided focused ultrasound technology uses an MRI to guide powerful focused ultrasound to a very small point in the body. At that point, the ultrasound causes molecules to vibrate extremely quickly, creating an intense local heat. That heat can destroy tissue. MR-guided focused ultrasound allows us to target a very specific focal point, ensuring that only targeted tissue is affected. This non-invasive procedure is used to treat a number of conditions, such as fibroids in the womb. But it has proved much more difficult to find a way to use this technology in the brain.

A new technique allowing focused ultrasound to be used in the brain has now changed that. International trials using MR-guided focused ultrasound to treat essential tremor – an uncontrollable shake of a part of the body caused by abnormal electrical circuits in the brain – show great promise. That’s why I advocated for the Trust to acquire this technology with the help of Imperial College Healthcare Charity and join the multinational trial for the treatment of essential tremor.

Our Trust is uniquely positioned to become a home for the use of MR-guided focused ultrasound in the brain: we are already pioneers when it comes to MR-guided focused ultrasound, as one of the first centres in the world to carry out these procedures on a regular basis. We have devised several new applications of the technology which are now used regularly around the world as standard treatments. We also have one of the largest motion disorder neurology setups in the UK and our Trust is a national referral centre for the treatment of patients with essential tremor and associated conditions. Our neurosurgeons and neurologists are some of the most eminent practitioners in this field in Europe. By uniting our unique expertise with this new cutting-edge technology, we can provide immense benefits to people with essential tremor.

While essential tremor can be treated with drug therapy, surgery or deep brain stimulation, these treatments can be invasive, their effects are limited and some have moderate risks. Essential tremor is very socially isolating. Many people with essential tremor report that others see them shaking and assume they are drunk, which makes them reluctant to go out. This new procedure provides non-invasive therapy to patients with no surgery whatsoever. It is a way of benefiting patients and keeping them out of hospital, with fewer risky procedures and little to no downtime for recovery.

It is remarkable to be able to treat a person with essential tremor using this new procedure. It fulfils everyone’s desire for immediate results, for the treating staff and for our patient, because we can see our patient getting better on the table. It’s very high powered technology and the work is very complex, but we can observe our patient improving in front of our eyes. It is a rare experience in medicine, and it really inspires passion in people.

One of our first patients who participated in the trial was very, very nervous at first. His pulse and his blood pressure shot up while we were preparing him for treatment – he was just so anxious. And then about halfway through the procedure, he started to smile. He could see and feel his tremor disappearing. When we finished the procedure, he was in tears. “You’ve changed my life,” he said to us.

All the work I've been involved with through focused ultrasound has been designed to get away from the traditional paradigm of surgery, which is to use a knife to open up the body. There’s no cutting at all, and it takes no more than a morning to complete the procedure. To me, that changes the paradigm, and it is really exciting.

It is common for us as physicians to be cynical about the potential impact of new medicines and technologies, because there is such a desire to find the next big therapy. But it is very difficult to argue with this treatment – it changes a person’s life before your eyes.

Read our news story to learn more about this technology.