Focused ultrasound (FUS) is an innovative, non-invasive technology that uses precisely targeted sound waves to treat deep areas of the brain without the need for surgery or radiation. UPMC offers state-of-the-art focused ultrasound through the UPMC Center for Image-Guided Neurosurgery (CIGNS), using the ExAblate Neuro system, first introduced to western Pennsylvania at UPMC Presbyterian in 2025.
Depending on the frequency used, focused ultrasound can either generate heat to treat conditions such as essential tremor and tremor-dominant Parkinson's disease, or create mechanical effects that temporarily open the blood-brain barrier. The second approach is currently under investigation to improve the delivery of medication for conditions such as brain tumors, epilepsy and Alzheimer's disease.
How Focused Ultrasound Works
Focused ultrasound treatments are guided by real-time MRI imaging, which allows for submillimeter precision and ongoing monitoring throughout the procedure. For essential tremor, between 30 and 40 ultrasound beams converge on a single target deep in the brain. Together they heat a small area, about 2 millimeters across or roughly the size of a standard pencil lead, to create a lesion in the precise region responsible for tremors.
Because the treatment is incisionless, focused ultrasound offers patients a faster recovery, fewer complications, and minimal side effects compared with traditional surgical approaches. Many patients with essential tremor or Parkinson's disease experience significant tremor reduction immediately after treatment. Bilateral focused ultrasound can treat essential tremor on both sides of the body.
Who Is a Candidate?
Focused ultrasound for essential tremor may be an option if you have not seen improvement after trying multiple medications. To be considered for treatment, you should:
- Be over 18 years of age.
- Have a diagnosis of essential tremor, which causes rapid involuntary shaking, generally more than five times per second.
- Have tried multiple medications without relief of your tremors.
Focused ultrasound may also be appropriate if you are not a candidate for deep brain stimulation, for example if you take blood thinners or cannot tolerate general anesthesia. It is not recommended if you cannot tolerate an MRI, such as when you have metal in your body or poor bone density, or if you are unable to lie still for an extended period.
Medication remains the first-line treatment for essential tremor. Other options your care team may discuss include deep brain stimulation and Gamma Knife radiosurgery.
Benefits of Focused Ultrasound
- No general anesthesia. You remain awake throughout the procedure.
- No hospital stay. Focused ultrasound is an outpatient procedure, and you can go home the same day.
- No incisions. The treatment uses ultrasound and MRI technology, with no cuts.
- Precise treatment. Ultrasound waves target an area about 2 millimeters across.
- Quick procedure. Treatment takes one to two hours.
- Quick recovery. Most people return to normal activities within a day or two.
- Quick results. Many people notice improvement in their symptoms during the procedure itself.
What to Expect
Before Your Procedure
You will have a full neurological workup with a neurosurgeon, who will explain the procedure and answer your questions. You will also have an MRI, a CT scan, and a bone density study based on the CT. Your team will tell you which medications to pause, including blood thinners or tremor prescriptions, and will ask you not to eat after midnight the night before. Because of the MRI, you will need to remove all metal items such as jewelry, watches, and glasses, and you should arrange transportation home.
During Your Procedure
After an IV is placed, your care team shaves your head so nothing disturbs the ultrasound waves and applies local anesthesia to your scalp. A frame holds your head still, and a crown-like device filled with cool water and fitted with ultrasound transmitters lets the neurosurgeon map every point within the brain. You then lie on a table that moves in and out of the MRI machine while the neurosurgeon controls the ultrasound beams from a computer.
The neurosurgeon first creates a test lesion that briefly pauses the activity of neurons in the target area without causing permanent change, then checks your tremor to confirm the location. Once the target is confirmed, the intensity is raised to create the lesion. You are moved out of the scanner and asked to write your name, draw a spiral, or perform a similar task to measure the effect. If needed, the team can repeat these steps up to three times. Most people see at least some improvement during the procedure.
Recovery
After the frame and crown-like device are removed, you move to an observation area for a couple of hours while your team monitors your vitals before you go home. Any temporary side effects, such as balance changes when walking, altered taste, or numbness, generally resolve within a couple of weeks. Tremor improvement often begins during and immediately after treatment, with the full effect appearing over a few weeks, and most people return to their normal routine within a few days to a week.
You will see your neurosurgeon for a follow-up two weeks to a month after the procedure, followed by an MRI a few months later and continued visits with your neurology team. If you are treated on both sides of the brain, the procedures are spaced at least a month apart.
Possible Side Effects
The main risk of focused ultrasound is creating a lesion in an incorrect area of the brain, which your care team works to prevent with multiple safety checks. During the procedure you may feel mild dizziness, nausea, or pain. Side effects afterward can include balance changes when walking, changes in taste, headache, numbness or tingling in the lips, mouth, or tongue, scalp irritation, and slurred speech. These are generally mild and tend to subside within a couple of weeks. Contact your doctor if any side effect does not improve or worsens.
Results
Most people begin to see improvement in their tremors during treatment and continue to improve afterward, with some experiencing up to an 80 percent reduction in tremor. Focused ultrasound is not a cure, and tremors may gradually return over several years. If that happens, your neurosurgeon can discuss whether you are a candidate for another treatment.
A Comprehensive, Patient-Centered Program
At the University of Pittsburgh, focused ultrasound is part of a comprehensive, patient-centered program led by a highly specialized multidisciplinary team. Each patient is carefully evaluated by experts across neurosurgery, movement disorders, epilepsy, and radiosurgery to determine the safest and most effective treatment path based on their unique clinical needs.
The program is co-directed by Costas Hadjipanayis, MD, PhD, director of the UPMC Center for Image-Guided Neurosurgery, and Jorge A. González-Martínez, MD, PhD, director of the UPMC Epilepsy and Functional Neurosurgery Program. Dr. González-Martínez is internationally recognized for his work in functional neurosurgery and epilepsy and is expanding the use of focused ultrasound for epilepsy, addiction, and psychiatric disorders through upcoming clinical trials. Dr. Hadjipanayis is a leader in minimally invasive therapies for malignant brain tumors and is developing investigational studies that combine focused ultrasound with novel therapeutic agents for difficult-to-reach tumors such as glioblastoma, brain metastases, and DIPG/DMG tumors.
The focused ultrasound program is integrated into UPMC's Movement Disorders and Epilepsy Program, one of the few in the country to offer the full spectrum of treatment modalities, including medication management, deep brain stimulation, laser therapy, radiosurgery, botulinum toxin therapy, and focused ultrasound. The multidisciplinary team also includes Ajay Niranjan, MD, a radiosurgery specialist, and Timoteo Almeida, MD, MSc, PhD, a stereotactic and functional neurosurgeon, both in the Department of Neurological Surgery; movement disorder specialists Houman Homayoun, MD, Valerie Suski, DO, and Sarah Berman, MD, PhD; and epilepsy specialists Thunder Aung, MD, and Alexandra Urban, MD, all from the Department of Neurology.
As one of a limited number of centers in the United States offering focused ultrasound for essential tremor, the team provides personalized counseling and expert care built on decades of experience treating complex neurological conditions.
Schedule a Consultation
Every patient referred for focused ultrasound undergoes a comprehensive, multidisciplinary evaluation of their medical history, condition, and overall health, and the team works together to build a treatment plan tailored to each patient's needs while prioritizing safety and long-term outcomes.
For more information on the UPMC focused ultrasound program, or to schedule a consultation, please contact Theodora Constantine at Constantinet@upmc.edu or Becky Miller at millrx@upmc.edu.