Focused ultrasound treatment for essential tremor has been approved by the Food and Drug Administration (FDA) in July 2016.
The neurosurgeons at Dallas Neurosurgical & Spine offer treatment options for a wide variety of conditions that are listed at right. For detailed information covering each condition, click on each condition to learn more. In many cases, you will find a link to our animations section at the end of each section to learn more. This session will highlight the advancements in the treatment of Parkinson’s Disease, Epilepsy, Trigeminal Neuralgia, Obsessive Compulsive Disorders and Essential Tremors using Stereotactic Radiosurgery from a few of the world’s leading neurosurgeons.
Essential tremor (ET) is the most common movement disorder, affecting an estimated 3% of the population, or approximately 10 million individuals in the United States. ET is commonly viewed as a relatively benign disease.
However, the associated disabling aspects of ET, such as significant tremor of the hands, can impair patients’ ability to eat, shave, write, perform household activities, and function in the workplace.
The underlying etiology of ET is unclear, but cases often run in families (familial tremor). It has been estimated that approximately 50% of all cases are due to a genetic mutation, and the pattern of inheritance is most consistent with autosomal dominant transmission (i.e. dominant trait).
![Gamma knife treatment for essential tremor in san antonio tx 10 Gamma knife treatment for essential tremor in san antonio tx 10](/uploads/1/2/5/2/125218392/856945397.png)
Focused Ultrasound Therapy
Focused ultrasound is a completely non-invasive method of thalamotomy - a procedure in which a predefined small volume of brain tissue containing nerve cells causing the tremor is destroyed - that could be an effective option for certain patients. It is performed while the patient is awake and involves no anesthesia, no incisions in the scalp, and no burr holes through the skull or insertion of electrodes into the brain.
Most clinical studies target a region in the thalamus involving the Vim nucleus and were performed on only one side of the brain. Recent studies from Switzerland demonstrated safety and efficacy in targeting a different part of the thalamus called the cerebellothalamic tract (CTT), below the thalamus. To learn more about the CTT approach see the Center for Ultrasound Functional Neurosurgery Solothurn website.
Focused ultrasound may offer the following benefits in treating ET:
Focused ultrasound may offer the following benefits in treating ET:
- It is a non-invasive, single treatment that enables patients to recover rapidly and quickly return to activities of normal life (usually the next day).
- Compared to RF ablation or DBS, focused ultrasound offers a reduced risk of infection, of damage to the non-targeted area, and of blood clot formation.
- Focused ultrasound offers rapid resolution of symptoms.
- In contrast to lesioning performed with stereotactic radiosurgery, focused ultrasound does not use ionizing radiation, thus avoiding the side effects of exposure to radiation.
- Because it is non-invasive, focused ultrasound could be an option for medically refractory ET patients (those who do not respond well to medication) who do not want to undergo surgery.
Clinical Trials
Phase 3 Pivotal Clinical Study
Enrollment has been completed in a multi-center pivotal randomized study to evaluate the safety and efficacy of focused ultrasound for the treatment of medication-refractory essential tremor patients. Results of this study have been reviewed and approved by the FDA.
Enrollment has been completed in a multi-center pivotal randomized study to evaluate the safety and efficacy of focused ultrasound for the treatment of medication-refractory essential tremor patients. Results of this study have been reviewed and approved by the FDA.
A clinical trial at The Ohio State University is looking at pre-targeting images to see if this can help in long term sustainability of ET treatments.
A clinical trial in the UK has begun and is doing staged bilateral treatments. This group will treat the second side after at least nine months have passed after the first treatment.
Treatment Sites
Please see a list of possible treatment sites here.
Regulatory & Reimbursement
The Exablate system manufactured by Insightec earned FDA approval to treat essential tremor in July 2016. It is also approved for treating essential tremor in Europe, Korea, Canada, Japan, Russia, Taiwan, and the Middle East.
In the US, Medicare, at a national level, allows payment, of approximately and most regional payment centers for Medicare are covering this procedure. However, there are still a few regions that are not, so patients should inquire from their physician regarding payment.
In the US, Medicare, at a national level, allows payment, of approximately and most regional payment centers for Medicare are covering this procedure. However, there are still a few regions that are not, so patients should inquire from their physician regarding payment.
Although the code for this care (0398T) has been approved to move to the payable class, it will not transition to the updated codes until late 2019. Until then, it is more likely that payment rejections will have to be appealed in order to ensure payment.
Commercial coverage and Medicaid will typically follow Medicare but should be evaluated with each company and region. Some facilities have a cash payment option, for those who are not willing to wait for insurance decisions for payment. Prices vary, but a rough estimate is $40,000.
Insightec has established an informational website, including patient stories and access to treatment site information. They have also set up a Reimbursement Support Manager, who can help with questions about the status of reimbursements. Her contact information is: Kim Martin, Reimbursement Support Manager, 1-(866) 392-8478 or .
Additional Information
Notable Papers
Jones RM, Kamps S, Huang Y, Scantlebury N, Lipsman N, Schwartz ML, Hynynen K. Accumulated thermal dose in MRI-guided focused ultrasound for essential tremor: repeated sonications with low focal temperatures. J Neurosurg. 2019 May 10:1-8. doi: 10.3171/2019.2.JNS182995. [Epub ahead of print] PMID: 31075781
D'Souza M, Chen KS, Rosenberg J, Elias WJ, Eisenberg HM, Gwinn R, Taira T, Chang JW, Lipsman N, Krishna V, Igase K, Yamada K, Kishima H, Cosgrove R, Rumià J, Kaplitt MG, Hirabayashi H, Nandi D, Henderson JM, Butts Pauly K, Dayan M, Halpern CH, Ghanouni P. Impact of skull density ratio on efficacy and safety of magnetic resonance-guided focused ultrasound treatment of essential tremor. J Neurosurg. 2019 Apr 26:1-6. doi: 10.3171/2019.2.JNS183517. [Epub ahead of print]
PMID: 31026836
Boutet A, Gwun D, Gramer R, Ranjan M, Elias GJB, Tilden D, Huang Y, Li SX, Davidson B, Lu H, Tyrrell P, Jones RM, Fasano A, Hynynen K, Kucharczyk W, Schwartz ML, Lozano AM. The relevance of skull density ratio in selecting candidates for transcranial MR-guided focused ultrasound. J Neurosurg. 2019 May 3:1-7. doi: 10.3171/2019.2.JNS182571. [Epub ahead of print]
PMID: 31051458
D'Souza M, Chen KS, Rosenberg J, Elias WJ, Eisenberg HM, Gwinn R, Taira T, Chang JW, Lipsman N, Krishna V, Igase K, Yamada K, Kishima H, Cosgrove R, Rumià J, Kaplitt MG, Hirabayashi H, Nandi D, Henderson JM, Butts Pauly K, Dayan M, Halpern CH, Ghanouni P. Impact of skull density ratio on efficacy and safety of magnetic resonance-guided focused ultrasound treatment of essential tremor. J Neurosurg. 2019 Apr 26:1-6. doi: 10.3171/2019.2.JNS183517. [Epub ahead of print]
PMID: 31026836
Boutet A, Gwun D, Gramer R, Ranjan M, Elias GJB, Tilden D, Huang Y, Li SX, Davidson B, Lu H, Tyrrell P, Jones RM, Fasano A, Hynynen K, Kucharczyk W, Schwartz ML, Lozano AM. The relevance of skull density ratio in selecting candidates for transcranial MR-guided focused ultrasound. J Neurosurg. 2019 May 3:1-7. doi: 10.3171/2019.2.JNS182571. [Epub ahead of print]
PMID: 31051458
Yang AI, Chaibainou H, Wang S, Hitti FL, McShane BJ, Tilden D, Korn M, Blanke A, Dayan M, Wolf RL, Baltuch GH. Focused Ultrasound Thalamotomy for Essential Tremor in the Setting of a Ventricular Shunt: Technical Report. Oper Neurosurg (Hagerstown). 2019 Mar 19. pii: opz013. doi: 10.1093/ons/opz013.
Pineda-Pardo JA, Martínez-Fernández R, Rodríguez-Rojas R, Del-Alamo M, Hernández F, Foffani G, Dileone M, Máñez-Miró JU, De Luis-Pastor E, Vela L, Obeso JA. Microstructural changes of the dentato-rubro-thalamic tract after transcranial MR guided focused ultrasound ablation of the posteroventral VIM in essential tremor. Hum Brain Mapp. 2019 Mar 13. doi: 10.1002/hbm.24569.
Gasca-Salas C, Guida P, Piredda R, Obeso I, Vela Desojo L, Martínez-Fernández R, Hernández-Fernández F, Máñez-Miró J, Pineda-Pardo JA, Del Álamo M, Rodriguez-Rojas R, Mata-Marín D, Alonso-Frech F, de Luis E, Obeso JA. Cognitive safety after unilateral magnetic resonance-guided focused ultrasound thalamotomy for essential tremor. J Neurol Neurosurg Psychiatry. 2019 Mar 8. pii: jnnp-2018-320129. doi: 10.1136/jnnp-2018-320129.
Pineda-Pardo JA, Martínez-Fernández R, Rodríguez-Rojas R, Del-Alamo M, Hernández F, Foffani G, Dileone M, Máñez-Miró JU, De Luis-Pastor E, Vela L, Obeso JA. Microstructural changes of the dentato-rubro-thalamic tract after transcranial MR guided focused ultrasound ablation of the posteroventral VIM in essential tremor. Hum Brain Mapp. 2019 Mar 13. doi: 10.1002/hbm.24569.
Gasca-Salas C, Guida P, Piredda R, Obeso I, Vela Desojo L, Martínez-Fernández R, Hernández-Fernández F, Máñez-Miró J, Pineda-Pardo JA, Del Álamo M, Rodriguez-Rojas R, Mata-Marín D, Alonso-Frech F, de Luis E, Obeso JA. Cognitive safety after unilateral magnetic resonance-guided focused ultrasound thalamotomy for essential tremor. J Neurol Neurosurg Psychiatry. 2019 Mar 8. pii: jnnp-2018-320129. doi: 10.1136/jnnp-2018-320129.
Harary M, Segar DJ, Hayes MT, Cosgrove GR. Unilateral Thalamic Deep Brain Stimulation vs. Focused Ultrasound Thalamotomy for Essential Tremor. World Neurosurg. 2019 Feb 19. pii: S1878-8750(19)30400-0. doi: 10.1016/j.wneu.2019.01.281.
Park YS, Jung NY, Na YC, Chang JW. Four-year follow-up results of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor. Mov Disord. 2019 Feb 13. doi: 10.1002/mds.27637.
Park YS, Jung NY, Na YC, Chang JW. Four-year follow-up results of magnetic resonance-guided focused ultrasound thalamotomy for essential tremor. Mov Disord. 2019 Feb 13. doi: 10.1002/mds.27637.
Weidman EK, Kaplitt MG, Strybing K, Chazen JL. Repeat magnetic resonance imaging-guided focused ultrasoundthalamotomy for recurrent essential tremor: case report and review of MRI findings. J Neurosurg. 2019 Jan 25:1-6. doi: 10.3171/2018.10.JNS181721.
Boutet A, Ranjan M, Zhong J, Germann J, Xu D, Schwartz ML, Lipsman N, Hynynen K, Devenyi GA, Chakravarty M, Hlasny E, Llinas M, Lozano CS, Elias GJB, Chan J, Coblentz A, Fasano A, Kucharczyk W, Hodaie M, Lozano AM. Focused ultrasound thalamotomy location determines clinical benefits in patients with essential tremor. Brain. 2018 Nov 17. doi: 10.1093/brain/awy278.
Meng Y, Solomon B, Boutet A, Llinas M, Scantlebury N, Huang Y, Hynynen K, Hamani C, Fasano A, Lozano AM, Lipsman N, Schwartz ML. Magnetic resonance-guided focused ultrasound thalamotomy for treatment of essential tremor: A 2-year outcome study. Mov Disord. 2018 Oct 4. doi: 10.1002/mds.99.
Krishna V, Sammartino F, Agrawal P, Changizi BK, Bourekas E, Knopp MV, Rezai A. Prospective Tractography-Based Targeting for Improved Safety of Focused Ultrasound Thalamotomy. Neurosurgery. 2018 Mar 21. doi: 10.1093/neuros/nyy020.
Jung NY, Park CK, Chang WS, Jung HH, Chang JW. Effects on cognition and quality of life with unilateral magnetic resonance-guided focused ultrasound thalamotomy for essential tremor. Neurosurg Focus. 2018 Feb;44(2):E8. doi: 10.3171/2017.11.FOCUS17625.
Chazen JL, Sarva H, Stieg PE, et al. Clinical improvement associated with targeted interruption of the cerebellothalamic tract following MR-guided focused ultrasound for essential tremor. J Neurosurg. October 2017:1-9. doi:10.3171/2017.4.JNS162803.
Kim M, Jung NY, Park CK, Chang WS, Jung HH, Chang JW. Comparative Evaluation of Magnetic Resonance-Guided Focused Ultrasound Surgery for Essential Tremor. Stereotact Funct Neurosurg. 2017 Aug 16;95(4):279-286. doi: 10.1159/000478866.
Niranjan A, Raju SS, Monaco EA 3rd, Flickinger JC, Lunsford LD. Is staged bilateral thalamic radiosurgery an option for otherwise surgically ineligible patients with medically refractory bilateral tremor? J Neurosurg. 2017 Apr 7:1-10. doi: 10.3171/2016.11.JNS162044.
Ravikumar VK, Parker JJ, Hornbeck TS, Santini VE, Pauly KB, Wintermark M, Ghanouni P, Stein SC, Halpern CH. Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor. Mov Disord. 2017 Apr 3. doi: 10.1002/mds.26997.
Schlesinger D, Lee M, Ter Haar G, Sela B, Eames M, Snell J, Kassell N, Sheehan J, Larner J, Aubry JF. Equivalence of cell survival data for radiation dose and thermal dose in ablative treatments: analysis applied to essential tremor thalamotomy by focused ultrasound and gamma knife. Int J Hyperthermia. 2017 Jan 3:1-27. doi: 10.1080/02656736.2016.1278281.
Hughes A, Huang Y, Pulkkinen A, Schwartz ML, Lozano AM, Hynynen K. A numerical study on the oblique focus in MR-guided transcranial focused ultrasound. Phys Med Biol. 2016 Nov 21;61(22):8025-8043.
Jang C, Park HJ, Chang WS, Pae C, Chang JW. Immediate and Longitudinal Alterations of Functional Networks after Thalamotomy in Essential Tremor. Front Neurol. 2016 Oct 24;7:184.
Hughes A, Huang Y, Pulkkinen A, Schwartz ML, Lozano AM, Hynynen K. A numerical study on the oblique focus in MR-guided transcranial focused ultrasound. Phys Med Biol. 2016 Nov 21;61(22):8025-8043.
Jang C, Park HJ, Chang WS, Pae C, Chang JW. Immediate and Longitudinal Alterations of Functional Networks after Thalamotomy in Essential Tremor. Front Neurol. 2016 Oct 24;7:184.
Elias WJ, Lipsman N, Ondo WG, Ghanouni P, Kim YG, Lee W, Schwartz M, Hynynen K, Lozano AM, Shah BB, Huss D, Dallapiazza RF, Gwinn R, Witt J, Ro S, Eisenberg HM, Fishman PS, Gandhi D, Halpern CH, Chuang R, Butts Pauly K, Tierney TS, Hayes MT, Cosgrove GR, Yamaguchi T, Abe K, Taira T, Chang JW. A Randomized Trial of Focused Ultrasound Thalamotomy for Essential Tremor. N Engl J Med. 2016 Aug 25;375(8):730-9. doi: 10.1056/NEJMoa1600159.
Bond AE, Dallapiazza R, Huss D, Warren AL, Sperling S, Gwinn R, Shah BB, Elias WJ. A Randomized, Sham-Controlled Trial of Transcranial Magnetic Resonance-GuidedFocused Ultrasound Thalamotomy Trial for the Treatment of Tremor-Dominant, Idiopathic Parkinson Disease. Neurosurgery. 2016 Aug;63 Suppl 1:154. doi: 10.1227/01.neu.0000489702.18785.5f.
Gallay MN, Moser D, Rossi F, Pourtehrani P, Magara AE, Kowalski M, Arnold A, Jeanmonod D. Incisionless transcranial MR-guided focused ultrasound in essential tremor: cerebellothalamic tractotomy. J Ther Ultrasound. 2016 Feb 13;4:5. doi: 10.1186/s40349-016-0049-8. eCollection 2016.
Click here for additional references from PubMed.
Pre- and post-treatment assessment videos courtesy of University of Virginia
![Gamma knife treatment for essential tremor in san antonio tx area Gamma knife treatment for essential tremor in san antonio tx area](/uploads/1/2/5/2/125218392/306561189.jpg)
Sort & Filter
Refine Your Search
Job Type
Minimum Salary
Date Added
US Department of Veterans Affairs - Syracuse, NY3.9
BC/BE general Neurosurgeon. The Syracuse Department of Veterans Affairs Medical Center (VAMC) has an opening for a full-time Academic Neurosurgeon....
University of Utah - Salt Lake City, UT4.2
Salary and academic appointment will be commensurate with qualifications and rank. Academic rank is open and will be dependent upon experience and...
U.S. Army - United States4.4
Our physicians excel in the clinical, research, operational, academic and health administration arenas....
University of Chicago - Chicago, IL4.2
Academic rank and compensation (including a generous package of fringe benefits) are dependent upon qualifications....
UMass Memorial Health Care - Worcester, MA4.0
ACADEMIC SPINE NEUROSURGEON. The academic rank will be commensurate with expertise and training. The Department of Neurological Surgery at UMass Memorial...
Washington University in St. Louis - Missouri4.1
Academic TeleStroke Neurologist The Department of Neurology at Washington University School of Medicine in St....
Indiana University - Indianapolis, IN4.3
The successful applicant will be expected to lead the multidisciplinary comprehensive stroke center, engage in academic pursuits and perform clinical or basic...
US Department of Veterans Affairs - Los Angeles, CA+1 location3.9
Responsible for sharing the call volume along with the other neurosurgeons on staff. Must have experience in spine surgery, and an academic focus in spine...
Baystate Health - Springfield, MA3.8
Baystate Health is seeking an Functional Neurosurgeon to join our established Neurosurgery team of neurosurgeons, neurologists, advanced practice providers, and...
University of North Carolina at Chapel Hill - Chapel Hill, NC4.2
Working Title Neurosurgeon. The Department of Neurosurgery at the University of North Carolina, Chapel Hill is seeking a board-certified or board-eligible...
HCA Healthcare - Houston, TX3.8
Guide the development of major neuroscience research initiatives, encouraging collaboration with other academic institutions for research purposes and...
Create Job Alert
Provide an email address© 2019 SH Inc. | Privacy | Terms