The Jiménez Díaz Foundation has added the use of high-intensity focused ultrasound (HIFU) to its treatments to control the symptoms of various movement disorders.
Advances in medical technology have improved the treatment of neurological disorders. A recent and promising development is high-intensity focused ultrasound ( HIFU ), used at the Jiménez Díaz Foundation to treat refractory tremor (a type of tremor that does not respond to conventional medical treatments, such as medications), focal dystonia (a movement disorder that causes involuntary and sustained muscle contractions in a specific part of the body), and neuropathic pain (chronic pain due to a dysfunction in the nervous system itself, without any damage having occurred). This procedure, already effective in the first patients treated, offers a less invasive and safer option than deep brain stimulation (DBS), the standard until now.
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What is HIFU?
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High-intensity focused ultrasound is a noninvasive technique that uses ultrasound beams to generate heat in specific areas of the brain , destroying tissue through coagulative necrosis and stopping neural signals that cause movement disorders. Guided by magnetic resonance imaging, HIFU precisely treats essential and parkinsonian tremor , and can also target the subthalamic nucleus in Parkinson’s, as well as relieving symptoms of focal dystonia and neuropathic pain in both strategies, neither of which is, however, curative.
Big differences
Until recently, DBS was the most common treatment to control the symptoms of tremor and other movement disorders. DBS involves the implantation of electrodes in deep areas of the brain that, through electrical stimuli, control involuntary movements. Although effective, this treatment requires a more invasive surgical intervention, with associated risks such as infections, problems with the adjustment of implanted electronic devices and the need for periodic check-ups. HIFU , in comparison, is a procedure that does not require open surgery , nor the implantation of devices, which significantly reduces the associated risks. The operation is performed in just 3 or 4 hours with the patient awake and with a minimal hospital stay, usually just one night. As Dr. Joaquín Ayerbe, a neurosurgery specialist at the Jiménez Díaz Foundation, points out, one of the great advantages of HIFU over DBS is precisely “its simplicity of execution”, which has been a key point for its adoption at the Foundation.
Few but great success stories
To date, the Jiménez Díaz Foundation has successfully treated 15 patients using HIFU, all over 70 years of age and diagnosed with essential tremor . According to Dr. Ayerbe, all patients were able to return to their daily activities 24 hours after the intervention, without requiring further rehabilitation. No significant side effects were reported , demonstrating the safety and efficacy of the procedure. This initial success not only underlines the viability of HIFU as a treatment for essential tremor, but opens the door to its use in younger patients and in more complex cases, such as those with tremor-predominant Parkinson’s. The medium-term goal is to increase the number of interventions and treat at least four patients per month ; betting on HIFU as a reference option in the hospital.
Selection criteria and benefits for patients
The profile of the HIFU candidate patient is key to ensuring success. Patients must meet certain inclusion criteria : a diagnosis of essential tremor or tremorigenic Parkinson’s disease, no significant cognitive impairment, and failure to respond to conventional pharmacological treatments. In addition, candidates must understand that the treatment is not curative, but rather seeks to relieve symptoms and improve their quality of life. Unlike other techniques, patients must not have indications for other lesional therapies or DBS, or must have rejected these alternatives. This selective approach ensures that patients who receive HIFU are those who will benefit most from its minimally invasive advantages . In addition to its simplicity, the procedure allows for avoiding the risks of infection and mechanical complications associated with implantable DBS devices. For many patients, these factors make HIFU a more attractive option, especially if they wish to avoid more invasive surgeries or are unwilling to undergo treatments that require constant medical monitoring.
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A multidisciplinary intervention
The success of HIFU at the Jiménez Díaz Foundation depends not only on the technology used, but also on the multidisciplinary collaboration of different specialties . The treatment is carried out with the coordinated participation of the Neurology and Neurosurgery services, as well as the Neuroradiology team, in charge of managing the magnetic resonance that guides the procedure. The Neurology team, led by Dr. Pedro García Ruiz and composed of doctors Javier del Val and Cristina García Campos, is responsible for selecting the appropriate patients and closely monitoring their progress. In parallel, the Neurosurgery team, under the direction of Dr. Mónica Lara, performs the intervention with precision and control, while doctors Julia Montoya and Cristina Ordóñez, from Neuroradiology, are in charge of the tasks related to the magnetic resonance.
Future uses
Although the use of HIFU has initially focused on essential tremor, the possibilities for expansion are broad. The Jiménez Díaz Foundation plans to include younger patients in its criteria, as well as those with Parkinson’s disease who present a high tremor component . In addition, it is hoped that HIFU can be used in the future to treat other conditions, such as neuropathic pain that does not respond to conventional treatments. This advance not only positions the Jiménez Díaz Foundation as a reference center in the treatment of movement disorders, but also underlines its commitment to healthcare excellence and technological innovation. The fact that it is the third public hospital in Madrid to offer this technique underlines once again its commitment to patients.
