FocusNeuro Tremor Treatment
Non-surgical treatment of tremor
What Are The Benefits of Focused Ultrasound treatment?
- It is non-invasive, with lower risks and a shorter recovery time
- It is carried out as a single treatment. Patients typically recover rapidly and quickly return to their usual daily activities (frequently within the next day or two)
- Compared to a radiofrequency ablation or deep brain stimulation, focused ultrasound is less risky, offering a reduced risk of infection, collateral damage, or bleeding
- Focused ultrasound offers rapid resolution of symptoms. Other technologies such as Gamma Knife radiosurgery have a significant delay before clinical improvement is seen, and deep brain stimulation requires regular programming of the electrical device, and either frequent recharging or further surgery to replace the battery when it expires
- In contrast to stereotactic radiosurgery lesioning, focused ultrasound does not use radiation, thereby avoiding the side effects of radiotherapy.
- No anaesthetic is required, therefore patient with signiciant medical comorbidity are eligible for this treatment
Focused Ultrasound- Now Available in Victoria, with Clinics Across Australia
Precision Brain Spine and Pain Centre, in conjunction with Future Medical Imaging Group, are proud to offer Neuravive, this new MRI-guided noninvasive treatment for essential tremor and tremor-dominant Parkinson’s disease. After a single treatment, most patients report an immediate significant relief or improvement in their symptoms. Focused ultrasound is capable of penetrating the skull without needing to make an incision or drill holes in the skull. MRI-guided focused ultrasound is effective, safe and convenient, with minimal side effects. By having the patient conscious during the procedure and perform a non-permanent “test lesion” to assess the likely benefit and rule out side effects, the procedure can be performed safely and reliably.
Dr Mina Ghaly
Dr Mina Ghaly is a neurologist with expertise in movement disorders.
Dr. Ghaly is the lead movement disorder neurologist at Precision Brain Spine and Pain Centre. He also holds a position at the Royal Melbourne Hospital and is a Movement Disorders Neurologist at St Vincent’s Hospital.
Mina has particular expertise in movement disorder neurology. He has expertise in a variety of conditions including:
- Parkinson’s disease
- Restless legs
- ‘Device Assisted Therapies’ such as Deep Brain Stimulation, Apomorphine, and Duodopa
Dr Ghaly prides himself on:
- An engaging, warm and compassionate bedside manner
- A thoughtful and methodological approach to the diagnosis and treatment of frequently complicated neurological conditions
- An evidence-based approach to movement disorder neurology
He also speaks fluent Arabic.
Dr Ghaly is also an active researcher in the field of Movement Disorders particularly, Parkinson’s disease.
Dr. Ghaly is a member of Royal Australasian College of Physicians (RACP), Australian and New Zealand Association of Neurologists (ANZAN), American Academy of Neurology (AAN), International Parkinson’s Disease and Movement Disorders Society (IPMDS), Movement Disorders Society of Australia and New Zealand (MDSANZ) and The Australian and New Zealand Headache Society (ANZHS). Visit the Precision Brain Spine and Pain Centre website.
Dr Andrew Dobrotwir
Dr Andrew Dobrotwir is a specialist Radiologist and Neuroradiologist at Future Medical Imaging Group.
Dr Andrew Dobrotwir is a specialist consultant radiologist and MR guided Focused Ultrasound Specialist at Future Medical Imaging Group.
Dr Dobrotwir is a founder and director of Future Medical Imaging Group. He established the first MR guided Focused Ultrasound treatment centre in Australia over a decade ago, pioneering world first treatments and has extensive practical experience in the field of Focused Ultrasound treatment. Published in this highly specialised field and sharing his wealth of knowledge, he both mentors and trains specialist colleagues in MR guided Focused Ultrasound treatment.
Professor Richard Bittar
Prof Bittar is a stereotactic and functional trained neurosurgeon with expertise in all aspects of movement disorder surgery.
After completing his neurosurgical training in Australia in January 2003 he undertook subspecialty training in stereotactic and functional neurosurgery in Oxford, under the guidance of Professor Tipu Aziz. He was the first Australian neurosurgeon to undertake fellowship training in this field, and has over 15 years of experience in deep brain stimulation. He is widely published in this field, with dozens ofscientific publications and conference presentations. He was the first neurosurgeon in Australia to perform deep brain stimulation for pain, depression and obsessive compulsive disorder, and the first in Victoria to carry our robotic spinal surgery. He is the founder and director of Precision Brain Spine Centre. Visit the Precision Brain Spine and Pain Centre Website.
How Does Neuravive Work?
Neuravive harnesses up to 1024 MR-guided high-intensity focused ultrasound beams, all aiming at a specific target in the brain, to create a “non-invasive” disruption to the brain tissue.
Ultrasound energy is non-ionizing, which means the patient is not exposed to radiation during the procedure. Normally ultrasound energy is non-destructive, but when it is focused on a small target the temperature of that tissue rises high enough to destroy it, thus providing a therapeutic effect.
An acoustic lens is used to concentrate multiple intersecting beams of ultrasound on a target deep in the brain with tremendous accuracy. The target can be varied to be as compact as 1.5mm or as large as16mm diametre.
In the same way as using a magnifying glass to focus beams of light on a single point to burn a hole in a piece of paper, where each individual ultrasound beam passes through the tissue, there is no effect. But, at the focal point, the multiple beams of focused ultrasound energy converge, and this results in many important biological effects.
A special (stereotactic) frame is attached to the patient’s head with local anaesthetic and the patient lies in the MR scanner for the procedure. A little sedation can be given to improve comfort and enhance relaxation during the procedure. No incisions are required and the patient is conscious throughout. The patient plays an important role in confirming that the correct region of the brain is being targeted.
During treatment, initially low energy ultrasound is applied to assess the response of tremor relief any potential side effects. This allows the treating team to make adjustments to the target before making the therapeutic and permanent brain lesion. Once the target has been localised and the initial testing carried out, the ultrasonic energy is progressively increased to create a permanent. This is done carefully, leading to a highly accurate and controlled lesion. Many patients experience an immediate improvement of tremor with minimal complications. Side effects, whilst common, are usually temporary, and may include transient balance issues. For this reason, we offer patients a short period of inpatient rehabilitation, under the supervision of one of our rehabilitation specialists or neurologists.
CE Indications for Use
Exablate has achieved CE Marking, which is the rigorous approval process for medical therapeutic devices in Europe, as well as TGA approval (the equivalent Australian regulatory body).
It is intended for thermal ablation of deep brain targets (thalamus, subthalamus and pallidum).
Exablate 4000 transcranial MR guided focused ultrasound can be used for the treatment of neurological disorders (Essential Tremor, Tremor Dominant Idiopathic Parkinson’s Disease) and neuropathic pain by heat-induced focused ultrasound energy with MR planning and thermal imaging control.
Which Conditions are Treated with MRgFUS?
MRI-Guided Focussed Ultrasound is currently used to treat conditions such as:
- - Essential tremor
- - Dystonic tremor
- - Parkinson’s Disease tremor
- - Post-traumatic tremor
- - We are currently exploring the option of treating chronic pain with this modality
What are the Advantages of Focused Ultrasound?
- Focused ultrasound is a non-invasive procedure. There are no incisions, no holes drilled in the skull, and no electrodes stuck into the brain. It therefore has reduced risks of infection, bleeding and stroke
- Precise targeting of the key structure minimises damage to surrounding healthy brain
- Unlike deep brain stimulation, focused ultrasound is a single procedure, and does not require further visits or surgeries to replace batteries or broken wires, or adjust stimulator settings
How can I be assessed for suitability for this treatment?
Patients with various types of tremor, as well as Parkinson’s Disease and dystonia, may be assessed for suitability for Neuravive.
Typically the assessment includes:
- Diagnostic confirmation of the type of movement disorder
- Measurement of skull density on CT, and brain morphology on MRI
- Assessment with the standard rating scales
- Consideration of quality of life issues
- Assessment of other health problems which may be relevant
The assessment team includes a neurologist, neurosurgeon, neuroradiologist, and sometimes a rehabilitation physician and neuropsychologist.
Are some patients not candidates for MR-guided focused ultrasound?
This procedure may not be suitable for patients:
- With non-MRI compatible implants, including some pacemakers, neurostimulators, spine or orthopaedic implants
- With extensive scarring on the scalp
- With tumours in the brain
- Who are on dialysis.
- Who have an active infection
- Who cannot lay still on a table for up to 4 hours
- Who are unable to stop antiplatelet or anticoagulation therapy
- Have significant claustrophobia