Norton Neuroscience Institute Cressman Parkinson’s & Movement Disorders Center will be the only site in Kentucky to offer high-intensity focused ultrasound (HiFU) for essential tremor and tremor-dominant Parkinson’s disease.

This potentially life-changing treatment is done with no incisions and improves tremor symptoms for most patients almost immediately. Most patients will be able to go home shortly after the procedure, with no need to stay overnight in the hospital.

HiFU treatment, also known as high-frequency focused ultrasound (fUS) and MRI-guided focused ultrasound (MRgFUS), is performed in an MRI machine.

HiFU treatment generates ultrasound waves that are thousands of times more intense than diagnostic ultrasound, with the energy focused on a tiny area. The energy creates heat that forms a small lesion, or ablation, in a specific area of your brain that is causing your tremor.

After the procedure, most patients experience dramatic and immediate relief of hand tremor. Most patients can expect an improved quality of life as they become able to use their hands better for life’s day-to-day tasks and hobbies.

The procedure is performed while you are lying in the MRI machine. Brief, frequent scans monitor the location, size and temperature of the lesion as it’s created. You’ll be awake, allowing your surgeon to test your tremor and neurologic function.

A frame will hold your head still, with the HiFU device on the top of your head to confine the ultrasound to the treatment area. Your surgeon will test your tremor and neurologic function as the treatment is taking place.

Focused ultrasound treatment can improve your tremor but won’t stop it completely. It can relieve symptoms and improve your quality of life, but it isn’t a cure.

The procedure delivers more than 1,000 ultrasound waves to the targeted tissue, about one-eighth inch in size, sparing nearby healthy tissue.

On the day of treatment, you will have to shave your head to improve the effectiveness of the high-intensity focused ultrasound technology. HiFU treatment takes about two hours. You’ll have a follow-up appointment the next day.

The HiFU procedure was approved by the Food and Drug Administration in 2016 after years of clinical trials to determine that it is safe and effective. Results of a pivotal clinical trial of the focused ultrasound thalamotomy were published in the New England Journal of Medicine.

Norton Neuroscience Institute is one of the first health care providers in the country to use an upgraded version of focused ultrasound called Exablate Prime. This upgraded technology allows for a faster procedure and improves your comfort on treatment day.

Medicare, Medicaid and major private insurance plans cover at least part of the procedure. Contact your insurer to learn about any out-of-pocket costs.

How Does Focused Ultrasound Work?

• No incisions: This technology lets us perform brain surgery without cutting the skin. Without incisions, there are fewer side effects than traditional surgery, and you have a low risk of bleeding, infection and slow recovery. You’ll usually be ready to go home shortly after the HiFU procedure and won’t spend the night in the hospital.
• No implants: This technology does not require an implanted device or stimulator, which means no risk of implant malfunction, movement, breakage or battery depletion.  Other effective treatments for Parkinson’s disease and essential tremor require implanting a device to interrupt the signals that trigger a tremor. With no implant, there’s no need to be concerned about device malfunction or low battery power.
• No anesthesia: This procedure is performed without anesthesia, in order to test your tremor. This means there is no recovery or risks from anesthesia. Without general anesthesia, your response to the treatment can be measured in real time. Throughout the procedure, we test for improvement of your tremor so that we will know exactly when the procedure is done.
• Precision: This technology lets us create a small lesion in exactly the right place. More than 1,000 ultrasound waves come together in one spot that’s a few millimeters in size. The ultrasound waves create heat, which creates the lesion. 
• Instant feedback: Throughout the procedure, we test for improvement of your tremor, as well as side effects, so we know exactly when the procedure is done

Is HiFU Treatment Right for You?

If your tremor is affecting your quality of life and medication isn’t helping, HiFU treatment may be an option. HiFU is one of a growing list of treatment options for tremor symptoms. Different options are right for different patients.

Your goals, symptoms and medical conditions are all part of the conversation you’ll have with your doctors before deciding on the treatment option that’s right for you.

HiFU treatment is often advisable if:

• You have a confirmed diagnosis of essential tremor or Parkinson’s-related tremor that is not adequately controlled with medication.
• You have a moderate to severe tremor and have tried at least two medications without suitable improvement.
• You are not a candidate for deep brain stimulation, which can help control tremors through the surgical placement of a neurostimulator.

What to Expect

Before Treatment

• You and your patient navigator will meet with a neurosurgeon and a movement disorders neurologist if appropriate, to discuss the benefits and risks of the procedure. As a team, you and your specialists will assess your condition to make sure focused ultrasound is right for you.
• MRI and CT scans will be performed before your procedure.

Treatment day

• We must shave your head to remove any air bubbles on hair follicles that can block the ultrasound waves.
• We apply a numbing medicine at four points on your scalp, then use pins to attach a frame. The frame holds your head still during the procedure.
• We fit you with the helmet-like HiFU device, filled with cool water, that delivers more than 1,000 ultrasound transmitters.
• You’ll lie on your back on a table that slides in and out of an MRI machine during the procedure.
• We obtain a baseline by asking you to perform simple movement tasks that bring out the tremor, such drawing a spiral or touching your nose.
• The MRI produces images of your brain and helps us guide the ultrasound waves.
• The first delivery of ultrasound waves will create a temporary lesion to confirm we are addressing the right spot in your brain.
• The treatment itself lasts about two hours, then you’ll go home.
• The next day, you’ll come back for an MRI to evaluate the lesion and any swelling.
• You may have brain swelling in the treatment area for two to three weeks. This could cause balance issues or some instability on your feet.
• Tremor symptom improvement will occur during the course of the procedure.

Side Effects During and After Treatment

During the procedure you many notice a brief moment of pain or headache. Some patients notice a burning sensation and feel nausea or dizziness.

After the procedure you may have some temporary imbalance or trouble walking. Other mild side effects after the treatment can include:

• Numbness and tingling in the fingers or around the mouth, lips or tongue
• Mild change in or decreased sense of taste
• Headache
• Dizziness
• Scalp irritation

Limits of High Intensity Focused Ultrasound

• This treatment vastly improves tremors in many patients, but, as with all medical and surgical treatments, it has limits and won’t stop the tremor completely.
• This is not a cure. Essential tremor and Parkinson’s disease are progressive, meaning they get worse over time. Treatment can slow the progression, but won’t cure the disease. After a period of time, you and your doctor may discuss whether a second focused ultrasound treatment is best for you. Another option may be deep brain stimulation.
• To be a candidate for the focused ultrasound surgery, you will need to be able to stay in the MRI without sedation. Any implants you have in your body will need to be MRI compatible.
• If there are sources of tremor on both sides of your brain, you will need to have focused ultrasound treatments at least nine months apart. For safety, we treat one side of the brain at a time.

Norton Healthcare Foundation

HiFU technology is funded with a $2.8 million grant from the Norton Healthcare Foundation. Learn how you can support innovation at Norton Neuroscience Institute.

The Norton Healthcare Foundation is the philanthropic arm of the not-for-profit Norton Healthcare system’s adult services.

Care That’s Focused on You

It’s part of Norton Neuroscience Institute’s goal to care for the whole person, not just the condition.

• Dedicated patient navigators can help schedule follow-up appointments, coordinate prescription assistance, create customized diet plans and provide guidance on disability benefits, housing, financial and employment concerns, and more.
• Patients can access support groups, exercise classes and other educational events to connect with others and learn how to make the most of life while managing a neurologic condition.
• Access an on-demand video library of educational content across a variety of condition-related topics is available.
• We want to help prevent illness. Get help quitting smoking, and learn the signs of stroke.

A Louisville Leader in Neurological Care

More patients from Louisville and Southern Indiana seek their neurology and neurosurgery care from Norton Neuroscience Institute’s nationally recognized specialists than any other providers in the area.

Your Norton Neuroscience Institute medical provider has the expertise, experience, diagnostic tools and sophisticated treatments to provide care tailored to your needs.

• More than 130 medical, surgical and research specialists are dedicated to providing innovative care to those with brain, spine and nervous system conditions.
• Advanced, minimally invasive neurosurgery equipment can speed your recovery and minimize pain.
• Multidisciplinary clinics provide easy access to care in one convenient appointment for your neurologic condition, with specialists in oncology, cardiology, orthopedics and behavioral health.
• Norton Healthcare’s four adult-service hospitals in Louisville are certified by DNV, recognizing excellence and expertise in stroke care.
  • Norton Brownsboro Hospital is recognized as a Comprehensive Stroke Center.
  • Norton Audubon Hospital and Norton Hospital are Primary Stroke Centers.
  • Norton Women’s & Children’s Hospital is an Acute Stroke Ready Hospital.
• Norton Neuroscience Institute is at the forefront of neuroscientific research. As investigators on numerous trials, our physicians contribute to groundbreaking studies and publications in peer-reviewed journals. Also, patients may be eligible to take part in these experimental treatments.
  Learn more about current neuroscience clinical trials and studies.
• The American Heart Association Get With the Guidelines stroke care program has recognized all four of Norton Healthcare’s adult service-hospitals in Louisville for exceeding national averages in getting patients in the door and administering lifesaving treatment to restore blood flow to the brain.
• Norton Neuroscience Institute’s multiple sclerosis (MS) program has been designated a Center for Comprehensive MS Care by the National Multiple Sclerosis Society.
• The National Association of Epilepsy Centers has recognized Norton Neuroscience Institute Comprehensive Epilepsy Center as a level 4 center, providing the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy.
• Norton Hospital’s neurosurgical intensive care unit is recognized with a silver-level Beacon Award for Excellence by the American Association of Critical-Care Nurses.
• Norton Neuroscience Institute Resource Center navigators help educate patients and their families about new diagnoses, available treatments and ways to manage their disease.
• Communicate with your provider, manage appointments, refill prescriptions, get an alert if an earlier appointment becomes available, and more anytime from a computer or mobile device with a free Norton MyChart account.