Neuro-HIFU Treatment for Parkinson's Disease and Essential Tremor

1. First contact. We review your case using the clinical information you send us to confirm whether you meet the initial criteria: a diagnosis of Parkinson's disease or essential tremor, no devices incompatible with MRI, and no significant claustrophobia.

2. Neurology consultation and skull CT. Neurocognitive assessment and CT scan to measure skull bone density and determine the technical feasibility of treatment.

3. Pre-anaesthetic tests. Blood tests, ECG, and chest X-ray so the anaesthetic team can assess your physical fitness before the session.

4. 3 T MRI, tractography, and volumetry. Precise identification of the brain point at which the ultrasound will be applied, while avoiding surrounding structures.

5. Neuro-HIFU session. Between 1.5 and 2 hours inside the MRI scanner. The patient is awake and a neurosurgeon evaluates the clinical response in real time before applying the definitive lesion.

6. Follow-up. Scheduled consultations and imaging to confirm the result and monitor progress in the short and medium term.

Neuro-HIFU is indicated for action tremor in essential tremor and resting tremor in tremor-dominant Parkinson's disease in patients with an insufficient response to medication. In selected cases it is also used for focal dystonia and refractory central neuropathic pain.

It is not effective for rigidity, bradykinesia, or non-motor symptoms of Parkinson's disease, which require standard pharmacological treatment and, in some cases, other surgical techniques such as deep brain stimulation (DBS).

• Non-open surgical procedure: no incisions, no craniotomy, no general anaesthesia. No prolonged hospital recovery required.
• Individualised treatment: the team assesses each case to define the target, trajectory, and application parameters.
• A single session: approximately 2 hours inside the MRI scanner.
• Immediate results: the patient notices tremor reduction before leaving the procedure room.
• No implants or batteries: unlike DBS, there is no subcutaneous generator to replace.

In unilateral essential tremor, published studies describe tremor reductions of 60-75% immediately after treatment, with benefit maintained in more than 50% of patients at 5 years. In tremor-dominant Parkinson's disease, improvement on the treated side is comparable. Functional recovery, including handwriting, eating with cutlery, and drinking without spilling, is typically immediate at discharge.

No. Neuro-HIFU creates a definitive thermal lesion without implanting anything and treats one side of the body per session. DBS implants deep electrodes and a subcutaneous generator: it is reversible, adjustable over time, and allows bilateral treatment. Each technique has its own indication and is decided on a case-by-case basis in a multidisciplinary committee. Learn more about DBS →

Most side effects are mild and transient. The most common during or immediately after the session are headache, dizziness, nausea, a sensation of heat in the head, and paraesthesia (transient tingling) in the hand or face on the treated side. These usually resolve within minutes or hours.

In a small proportion of patients, mild paraesthesia, balance disturbance, or some difficulty with fine motor coordination may persist for weeks or months. Serious side effects are uncommon thanks to real-time thermal control by MRI.

The entire procedure is performed with low-power test sonications before the definitive lesion, allowing the target to be repositioned if an adverse effect appears, thereby minimising risk.

The patient goes home the same day, after 2-4 hours of observation. For the first 24-48 hours it is generally advisable to rest and avoid strenuous physical activity. Usual medication is resumed as directed by the team.

Most patients return to normal life within 24-48 hours: social activity, walking, reading, and normal eating. Mild fatigue during the first week is common.

We schedule follow-up reviews at one week, one month, and at 3, 6, and 12 months, with imaging and clinical scales to document the stability of the result.

The thermal lesion produced by HIFU is permanent, but tremor may partially recur in a minority of patients over the years, particularly in essential tremor. Available studies describe maintenance of benefit in more than 50 % of patients at 5 years. If a clinically relevant recurrence occurs, retreatment with HIFU or deep brain stimulation (DBS) as a second-line option may be considered.

Neuro-HIFU treatment is currently unilateral: in one session the thalamus contralateral to the most affected side of the body is targeted. Creating bilateral lesions simultaneously or in close succession has classically been associated with a higher risk of side effects on speech, balance, and swallowing.

Staged bilateral treatment is in advanced clinical trials but is not yet standard outside research protocols. If your tremor is clearly bilateral and disabling on both sides, we will discuss during your assessment whether HIFU is the best option or whether bilateral DBS should be considered.

There is no formal age limit. In fact, HIFU is particularly useful for older patients for whom craniotomy or DBS implantation carries significant anaesthetic or surgical risk, since it is performed under local anaesthesia with same-day discharge. What matters is not chronological age but the patient's functional and cognitive status, the absence of MRI contraindications, and skull bone density compatible with the technique.

Yes. Situations that may contraindicate treatment include:

• Low skull bone density (SDR index < 0.40 on CT), which impedes ultrasound penetration.
• Devices incompatible with MRI (some pacemakers, incompatible metal implants).
• Severe claustrophobia or inability to remain still in the MRI scanner during treatment.
• Significant cognitive impairment that prevents cooperation during the session.
• Other medical criteria assessed on a case-by-case basis.

Usually between 4 and 8 weeks, depending on the availability of investigations (skull CT, 3 T MRI, anaesthetic assessment) and the patient's schedule. For international or out-of-region patients, we coordinate part of the preparatory tests with their home hospital to reduce travel.

Yes. We see national and international patients. You can send us your reports and imaging for an initial assessment without travelling. If we consider you a potential candidate, we arrange a video consultation with the team and only ask you to travel to Barcelona when strictly necessary for tests that cannot be coordinated remotely. Request a remote assessment →

The cost depends on the investigations required (CT, 3 T MRI, pre-anaesthetic tests), the type of treatment, and the follow-up plan. After the initial assessment we provide a detailed, personalised quote. For international patients we also coordinate the logistical aspects of travel and accommodation. Contact our team for specific information about your case.