Queen Square Imaging Centre: New technique could improve outcomes for essential tremor patients

Now, a new technique using FAT1 imaging - a sophisticated MRI approach that fuses multiple scan types - is offering hope to patients. Now, a new technique using FAT1 imaging - a sophisticated MRI approach that fuses multiple scan types - is offering hope to patients. A study inBMJ Neurology Openstudy reports the first use of FAT1 imaging to guide focused ultrasound for essential tremor. Traditionally, clinicians have relied on generalised brain maps to estimate the location of the target...

Now, a new technique using FAT1 imaging - a sophisticated MRI approach that fuses multiple scan types - is offering hope to patients.

A study in BMJ Neurology Open study reports the first use of FAT1 imaging to guide focused ultrasound for essential tremor. Traditionally, clinicians have relied on generalised brain maps to estimate the location of the target area within the brain - the Ventral Intermediate Nucleus (Vim) - which is extremely small and hard to visualise on standard MRI scans.

FAT1 imaging overcomes this by giving surgeons a direct view of the individual patient's Vim, enabling treatment to be precise.

"FAT1 imaging is a game-changer," said Mr Harith Akram, a consultant neurosurgeon at Queen Square Imaging who developed the technique and led the research. "By improving the visibility of the brain structures we need to target, we can deliver this non-invasive treatment with greater accuracy, faster results and fewer side effects, making a meaningful difference to patients' lives."

Study highlights:

Unlike traditional treatments such as Deep Brain Stimulation (DBS) or Radiofrequency Ablation (RFA), MRgFUS is completely non-invasive and incisionless. It focuses sound waves to gently heat and destroy the tremor-causing area of the brain under real-time MRI guidance.

With no surgery, no implants and a quicker recovery, MRgFUS is becoming the treatment of choice for eligible patients who do not respond to medication.

"This study represents the future of tremor treatment," added Mr Akram. "With new techniques like FAT1 imaging, we're able to personalise care in a way that is safer, smarter and more effective and ultimately give patients a better chance at regaining control and improving their quality of life."

Patients should always seek the advice from a professional and discuss their condition with a neurologist or movement disorder specialist for suitability.

Mr Harith Akram - consultant neurosurgeon at Queen Square Imaging Centre- developed the FAT-1 imaging technique and led the research.

Mr Akram is a pioneer of connectivity guided thalamic guided surgery for tremor and the Editor-in-chief of the World Society of Stereotactic and Functional Neurosurgery (WSSFNS) newsletter.

Study: San San Xu ,1,2 Harith Akram,1,2 Valentina Lind,1,2 Jonathan Hyam,1,2 Indran Davagnanam,3 Prasad Korlipara,2 Tabish A Saifee,2 Thomas Foltynie,1,2 Ludvic Zrinzo,1,2 Patricia Limousin,1,2 Marie T Kruger1,2,4. FAT1-weighted MRI-guided focused ultrasound thalamotomy for essential tremor. BMJ Neurology Open 2025;7:e001104. doi:10.1136/bmjno-2025-001104 

Additional supplemental material online: https://doi.org/10.1136/bmjno-2025-001104.

Queen Square Imaging Centre:

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