Department of Neurology, Division of Neurology, Physician Jui-Cheng Chen

(Case 1)

74-year-old Patient, Mr. Chow, suffering from “essential tremor” since 10 years ago would shake hands involuntarily.  Mr. Chow would shake hands constantly from signing the signature when he went to withdraw money from the bank, which behavior drew special attention the bank tellers and guards and made Mr. Chow quite embarrassed. After receiving the treatment, Mr. Chow can write “legibly” from previous cursive writing, he no longer shakes hands and will not be misunderstood when drawing money from the bank.  

(Case 2)

64-year-old patient, Mr. Huang, suffering from “essential tremor” since the age of 20 something, experienced much inconvenience in life due to constantly shaking hands. He needed help from his family when drinking water or eating, which condition aggravated in the last five years. Recently Mr. Huang sought for medical treatment at CMUH and after the received treatment from the “Magnetic Resonance-guided Focused Ultrasound” medical team, led by director of department of neurology and former Taiwan Movement Disorder Society director, professor Chon-Haw Tsai, Mr. Huang no longer suffered from tremor.  

CMUH Division of Neurology Attending Physician Ming-Kuei Lu suggested that “essential tremor” is usually the postural or action tremor symmetrical to dominance in genetics and often occurs at youth or senior period, which condition progresses slowly. There is yet no likely pathological mechanism that could be defined but the majority of studies regard the mechanism as related to brain stem and cerebellum.  

China Medical University Hospital Hsinchu Branch – Department of Neurology, Division of Neurology Physician Jui-Cheng Chen indicated that traditional treatment for “essential tremor” uses medication for treatment but approximately 30% of patients could not adapt due to poor medication effect or too many side effects. Although there is another option for surgery, fortunately the application of “Magnetic Resonance-guided Focused Ultrasound” provides a new choice that does not require surgery and is non-invasive, which is also likely to substantially improve the symptoms.  

Magnetic Resonance-guided Focused Ultrasound” is abbreviated as MRgFUS; a non-invasive and woundless precision treatment. The treatment process does not involve anesthesia and hence there is no concern for infection, hemorrhage and other complications. “Magnetic Resonance-guided Focused Ultrasound” requires the precise position of the target, where the physicians aim the beam at the target area through monitor operations while magnetic resonance guide improves the problems derived from position error. During the treatment, the physician will make tremor evaluation next to the patient and search for the position of symptom improvement from the monitoring through the instant temperature monitoring system of magnetic resonance, which precise burning substantially upgrades the cure rate. Nonetheless “MRgFUS” treatment can also come with side effects. Approximately 10% of patients will experience stings all over the body and imbalance during walking, which currently is excluded from the National Health Insurance.  

The indications of “MRgFUS” in Taiwan are currently essential tremor and this treatment is expected to favor more patients in urgent need of treatment.