Device profile of exAblate Neuro 4000, the leading system for brain magnetic resonance guided focused ultrasound technology: an overview of its safety and efficacy in the treatment of medically refractory essential tremor

ABSTRACT

Introduction: Magnetic Resonance guided Focused UltraSound (MRgFUS) is an emerging technique that utilizes multiple high-energy low-frequency ultrasound beams generated from a multi-element transducer focused onto a single site to cause thermal ablation of the target tissue. The ExAblate Neuro 4000 system is the leading MRgFUS brain system, performing targeted thermal ablation on specific nuclei in the brain. Its precision targeting opens up new and exciting possibilities for future treatments of a wide range of neurological diseases.  Areas covered: This article aims to introduce the non-expert reader (clinician and non-clinicians) to the role of the ExAblate Neuro 4000 System in brain MRgFUS. The current clinical uses of the ExAblate system in the brain are explored with a particular focus on Essential Tremor, where internationally there is most experience, this includes reference to current literature. The safety and efficacy of MRgFUS treatments are explored and the challenges the ExAblate system must overcome to balance these juxtaposed outcomes.Expert opinion: We describe the hopes for future clinical uses of the ExAblate Neuro 4000 system to treat neurological disease and consider further advancements in MRgFUS transducer technology that may open up new exciting frontiers within the brain.

KEYWORDS:

• Essential tremor
• Magnetic Resonance guided Focused Ultrasound
• Magnetic Resonance
• Ultrasound
• Tremor
• Movement Disorders
• Thalamotomy

Article Highlights

• Essential Tremor (ET) is the most common movement disorder worldwide and characterised by an action tremor of both arms. For medically refractory essential tremor, the mainstay of treatment is currently Deep Brain Stimulation, an invasive neurosurgical procedure.

• Magnetic Resonance guided Focused Ultrasound (MRgFUS) is an emerging non-invasive technique that uses multiple high-energy, low-frequency ultrasound beams focused onto a single target tissue generating heat and causing thermal ablation of the target.

• The ExAblate Neuro 4000 is the leading brain MRgFUS system which allows sub-millimetre precision targeting of brain nuclei. For the treatment of ET it utilises MRgFUS to target and thermally ablate tremor-specific nuclei, leading to tremor suppression in the contralateral arm.

• Several successful clinical trials have proven the safety and efficacy of ExAblate Neuro 4000 in the treatment of medically refractory ET, leading to a growing number of international centres adopting this technique.

• As the brain MRgFUS field expands with further technical advances and clinical research, the utility of the ExAblate system to treat neurological conditions beyond movement disorders expands. The future of brain MRgFUS is dynamic and rapidly expanding.

Declaration of interest

Previous clinical MRgFUS trials by all the authors have been part funded by commercial funding from InsighTec Plc and part funded by charities including the Imperial Health Charity and St Mary’s Development fund. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.