MR Guided Focused Ultrasound (MRgFUS)

MRgFUS treats tremor by focusing hundreds of ultrasound beams through the intact skull onto a single point deep inside the brain, where their combined energy creates a small, precisely placed lesion. Each individual beam is too weak to affect the tissue it passes through; only at the focal point does the energy become therapeutic.

Nothing is cut and nothing is implanted. The patient lies inside an MRI scanner wearing a helmet-shaped transducer, awake and in conversation with the team throughout.

The technique is a modern, image-guided version of thalamotomy — a procedure performed for decades — with the crucial difference that the target can be tested at low energy first, and adjusted, before anything permanent is done.

The head is shaved and a lightweight frame is fitted so the skull stays in a fixed position. Inside the scanner, MRI thermometry shows the team the temperature at the target in real time — this is what makes the procedure controllable rather than approximate.

Treatment proceeds in stages. Low-energy sonications warm the target just enough to produce a temporary effect. Between each one the patient is asked to draw a spiral, pour water, or hold out the hand. If the tremor settles and no unwanted effects appear, the energy is increased. If something is not right — numbness, altered speech, imbalance — the target is moved before any permanent change is made.

Most patients see the tremor in the treated hand reduce during the session itself. The whole procedure typically takes two to four hours.

The skull density ratio is the one criterion patients rarely expect. Ultrasound has to travel through bone to reach the target, and in a minority of people the skull absorbs too much of the energy for the procedure to be effective. This is measured on a CT scan before treatment is offered, and it is a reason we ask for imaging before you book anything.

MRgFUS is usually performed on one side of the brain, treating the opposite side of the body. Treating both sides is approached with much greater caution because of the risk of speech and balance effects. If tremor disables both hands equally, DBS is often the more appropriate option.

There is no wound to heal and no hardware to settle. Most patients stay one or two nights for observation, and the total stay in Istanbul is typically five to seven days: a day of pre-operative testing, the procedure day, and a short observation period before travel clearance.

Because the skull is never opened, flying is usually cleared within a few days rather than the 10–14 days required after DBS.

Temporary side effects are common in the first weeks — unsteadiness, tingling in the lips or fingers, mild gait disturbance — and usually settle. Because the lesion is permanent, any effect that persists cannot be reversed by adjusting a device. That asymmetry with DBS is the trade-off at the centre of the decision.

In practice the choice usually turns on three questions: is the tremor one-sided or two-sided, are there symptoms beyond tremor, and how much does the patient value reversibility. Send us your records and we will set out which way your case points — including when the answer is neither.

Treatment takes place at PARMER, Medipol Acıbadem District Hospital, a JCI-accredited centre within Medipol Health Group.

Because you are awake and reporting what you feel throughout the session, a medical interpreter is present for the whole procedure — not on a phone line. Your coordinator arranges the pre-treatment CT and MRI, the invitation letter for your visa, transfers, accommodation near the hospital, and the scheduled follow-ups after you return home.