- MRI-guided focused ultrasound (MRgFUS) is a relatively new technology rapidly becoming a treatment of choice for essential tremor.
- The technology is housed within The Florey’s Heidelberg brain imaging facility and is used by Austin Health specialists working alongside Florey imaging experts.
- Richard Mulcahy lived with an uncontrollable tremor for decades before undergoing transformative treatment through MRgFUS.
MRI-guided focused ultrasound for essential tremor
After decades of living with an uncontrollable tremor, Richard Mulcahy was fed up. He was tired of his hands shaking so much he couldn’t write properly, frustrated that he couldn’t use a knife and fork, and challenged by everyday activities like trying to button his shirt.
“I couldn’t eat soup without spilling it everywhere. Shaving became more difficult, even with an electric shaver, it was bouncing over my face because of my hand movement. Writing and typing were really hard and my head tremor meant people thought I was a really old man,” says the former MP and businessman.
Richard’s condition, known as essential tremor, began in his 20s. Thanks to a collaboration between The Florey and the Austin Hospital, Richard’s shaking is a thing of the past.
MRI-guided focused ultrasound (MRgFUS) is a relatively new technology rapidly becoming a treatment of choice for essential tremor.
“The procedure reversed all of my disabilities in a matter of hours. Most medical procedures require a recovery period, whereas with focused ultrasound in the MRI, the effects are immediate. It’s a dramatic procedure. I’m glad I’ve been the beneficiary of this treatment.”
They fixed the shakes on my left side. They’re gone completely, and so is my head tremor…That was the day my life changed. The procedure was miraculous.
The technology platform enabling Richard’s treatment is within The Florey’s Heidelberg brain imaging facility, adjacent to the Austin Hospital. It’s utilised by Austin specialists working alongside Florey imaging experts who scan the patient’s brain to identify a precise target the size of a rice grain deep within the brain.
Patients are awake throughout the incisionless treatment. While they are undergoing an MRI brain scan they receive a series of short, precisely focused bursts of ultrasound, which gently heat the target tissue.
With pin-point accuracy, the heat deactivates the misfiring circuit of nerve cells in the thalamus that cause the tremor. After each ultrasound burst, the patient is asked to draw a spiral and write their name. Just one hour after the treatment began, Richard’s spirals had changed from zig zags to smooth circles and his writing was legible.
Associate Professor Wes Thevathasan – Neurologist at Austin Health and Head of The Florey’s Movement Disorder Group – was part of Richard’s treatment team, with neurosurgeon Kristian Bulluss.
“I’ve done quite a few of these procedures now, and the outcome is rapid, dramatic, and transformative for the patient.”
The only alternative treatment for severe tremor like Richard’s is deep brain stimulation through electrodes implanted in the brain. However, that requires open brain surgery, and a 5-day stay in hospital.
The $6m MRI scanner and focused ultrasound equipment is the only such platform in Australia within a research institute. It was jointly funded for research purposes by The Florey, the University of Melbourne, and the National Imaging Facility (NIF) – under the Australian Government’s National Collaborative Research Infrastructure Strategy – and the Victorian Higher Education State Investment Fund.
NIF Chief Executive Professor Wojtek Goscinski said MRI technology like this is crucial to developing precision therapies. “We’re proud to support The Florey in providing precise real-time visualisation of brain structures. Seeing the human brain in detail enables doctors to provide more effective treatments.”
Associate Professor Thevathasan said: “By combining The Florey’s advanced brain imaging research expertise, Austin Health’s clinical experience and the NIF network, we’re making a real difference to patients’ lives. We’re embedding MRgFUS in the public health system, so more patients can benefit from this remarkable procedure.”
