Incisionless brain procedure eliminates Parkinson's tremors for air force veteran
· News-MedicalTo the untrained eye, a "ham" radio may look like a simple device. However, inside its casing, dozens of delicate wires and tiny elements perform distinct yet connected functions to deliver messages to a vast network of operators around the world.
Repairing these communication devices requires perseverance and a steady hand, qualities Keith "Bud" Leavell had long been known for. A retired Air Force veteran, Mr. Leavell had developed a passion for repairing ham radios toward the end of his civilian career in sales.
However, in 2017, he developed a tremor in his right hand, only hours after having surgery for thyroid cancer. His vocal range, pitch, and volume also diminished rapidly.
He also developed bradykinesia (slow movements) and rigidity (stiffness), which, together with the tremor, led to a diagnosis of Parkinson's disease.
"The logical thought was that the voice changes were a result of the surgery," Mr. Leavell, 72, remembers. "Turns out, it was a symptom of Parkinson's disease. I'd lost my sense of smell a few years earlier, which looking back, was likely an early symptom too."
He began taking the medication levodopa, which helped relieve some of his symptoms, but his hand tremor persisted. Although levodopa helps control tremor in most people with Parkinson's disease, it is less effective for this symptom in some patients. For Mr. Leavell, the persistent tremor prevented him from working on his radios and diminished his quality of life.
But Mr. Leavell isn't one to take a challenge lying down. When a friend sent him an article about a new incisionless brain procedure for tremor called transcranial MR-guided high-intensity focused ultrasound (MRgHIFU), he jumped at the opportunity.
A local neurologist referred him to Bhavya R. Shah, M.D., who is part of UT Southwestern's multidisciplinary movement disorders program in the Peter O'Donnell Jr. Brain Institute. UTSW brings together specialists from various disciplines to care for patients across all stages of Parkinson's and other diseases.
As part of the initial clinical assessment, movement disorder neurologists examine each patient and characterize how the disease is causing specific clinical symptoms. During this visit, the patient is educated on treatment options including medication management, MRgHIFU, and deep brain stimulation (DBS). This approach provides the opportunity to pair the best treatment to an individual patient's disease process.
After living with hand tremors for nine years, Mr. Leavell said they were gone minutes after his MRgHIFU procedure in April 2026.
How does MRgHIFU work for Parkinson's?
Not unlike a ham radio, the brain is composed of circuits, connections, and areas of matter that all have special functions. When a patient's thalamus and basal ganglia – brain regions that manage motor and other functions – are impeded by Parkinson's disease (PD), symptoms such as tremor, slowness, and stiffness can develop. MRgHIFU can treat these symptoms without incisions or open brain surgery.
During the MRgHIFU procedure, ultrasound beams are focused on a single point in the brain. Dr. Shah and his team have developed advanced imaging approaches to map the relevant brain circuit anatomy on an individual patient level. Pairing this methodology with real-time MR thermal imaging allows clinicians to target patient-specific, discrete brain regions, increasing the precision of the technology.
"The beauty of focused ultrasound technology is that, before we permanently ablate tissue with high-energy ultrasound waves, we first deliver low-energy waves to see if the patient's symptoms respond to the particular target," said Dr. Shah, Associate Professor of Radiology and a member of UTSW's Neuroradiology Division.
The high-energy ultrasound waves heat up the nuclei or nerve bundles and burn them, short-circuiting the source of tremors or other symptoms. The procedure takes less than two hours, including before-and-after MRIs to assess how the brain responded to the treatment. Patients are awake during the procedure so the team can assess treatment response in real time.
Leading MRgHIFU expertise at UTSW
Dr. Shah and the movement disorder neurologists have performed nearly 450 MRgHIFU procedures for essential tremor and Parkinson's disease. UTSW is one of just a handful of centers nationally that ensures the involvement of two physicians – an interventional neuroradiologist and a movement disorders neurologist – in each MRgHIFU case.
UT Southwestern is ranked No. 9 for Neurology & Neurosurgery on U.S. News & World Report's annual Best Hospitals list for 2026-2027.
While MRgHIFU is a safe and effective option for people with essential tremor or Parkinson's disease, it is a relatively new treatment without long-term efficacy data for MRgHIFU in Parkinson's. Deep brain stimulation remains the most studied and most widely available treatment for Parkinson's motor symptoms, and it is an effective therapy for many patients.
"Both DBS and MRgHIFU precisely target the same motor circuitry, but each uses a different mechanism to alter it. The differences can make either one a more attractive solution for a particular patient," said Padraig O'Suilleabhain, M.D., a Professor in the Department of Neurology who specializes in the treatment of movement disorders. "DBS has a long track record of success in controlling essential tremors as well as tremors and other movement difficulties in Parkinson's disease, with the major benefit that DBS can be adjusted over time for greater symptom control or to reduce side effects."
At UTSW, specialists in Neurology, Neurosurgery, Neuroradiology, and other disciplines collaborate to carefully evaluate each patient and recommend the treatment that offers the greatest potential benefits.
"Every new advance gives us another opportunity to better personalize care for people with Parkinson's disease," said Vibhash Sharma, M.D., Associate Professor of Neurology and Medical Director of UTSW's Neuromodulation Movement Disorders Clinic. "Having access to the full range of advanced therapies allows us to match the right treatment to the right patient based on their needs and goals. That's why multidisciplinary care is essential."
What are the possible risks of MRgHIFU for tremor?
While MRgHIFU is generally safe, there are risks associated with any brain procedure. About 20%-30% of patients will have temporary side effects, typically due to normal post-procedural swelling of the brain. These can include:
- Balance issues
- Numbness and tingling around the mouth and fingertips
- Trouble walking, talking, or swallowing
- Weakness in the upper or lower extremities
In 2022, Dr. Shah and colleagues developed four-tract tractography – an improved targeting method that uses patient-specific, real-time imaging to home in on the treatment target in the patient's brain. This advanced imaging approach enhances the precision of the procedure and can reduce the risk of side effects.
History of MRgHIFU
The FDA approved MRgHIFU for essential tremor in 2016, with the caveat that the treatment could only be applied on one side of the brain. Second-side procedures were approved in 2022.
MRgHIFU for tremor-dominant Parkinson's disease was approved in 2018. The FDA approved MRgHIFU treatment of Parkinson's mobility, rigidity, and dyskinesia symptoms in 2021; second-side treatment was approved in 2025. In 2026, staged, bilateral pallidothalamic tract treatment was approved.
A twist before the procedure
Previously, MRgHIFU was approved only for essential tremor, which involves shaking during actions such as picking up a fork or buttoning a shirt. In early 2026, the Food and Drug Administration (FDA) approved MRgHIFU for the pallidothalamic tract for motor symptoms of PD. Targeting this new area can also help improve slowness and stiffness, in addition to tremor.
For Mr. Leavell, targeting the pallidothalamic tract produced significant and immediate results.
"After the procedure, Dr. Shah asked me, 'How's the tremor?'" Mr. Leavell said. "My response was short and sweet: 'What tremor?'"
In the few weeks after Mr. Leavell's MRgHIFU procedure, the slowness and stiffness of his movements also improved. All patients who get this procedure are recommended to attend physical therapy to help improve their strength, balance, and coordination.
Most patients will continue taking medications to help manage Parkinson's symptoms beyond what is treatable by MRgHIFU. These symptoms include anxiety, depression, constipation, and cognitive decline.
"I'm taking carbidopa-levodopa, and that's the only thing I'm taking for Parkinson's," Mr. Leavell said. "We decided we're going to keep the medication where it is because there are other symptoms."
Who is a candidate for MRgHIFU?
MRgHIFU is available for adult patients with essential tremor or Parkinson's disease who meet certain criteria, including:
- Diagnosis confirmed by a movement disorder neurologist.
- Confirmation that the tremors, stiffness, or slowness are not effectively managed by medication alone or if PD medications are causing dyskinesia.
Patients who opt to have MRgHIFU will have imaging studies that allow the team to plan the procedure. First, a CT scan is done to calculate skull thickness because the ultrasound energy needs to be able to cross into the brain. A brain mapping MRI using advanced imaging techniques will also be done to precisely visualize the patient-specific target. During the first phase of treatment, low-intensity focused ultrasound is delivered to that target and the patient is then evaluated for clinical effects before the energy parameters are increased to create a permanent lesion. This assessment is performed by a board-certified movement disorder neurologist who is part of the treatment team.
Parkinson's is a progressive disease. Symptoms may return or new symptoms may emerge. MRgHIFU is not a cure, but it is a safe, effective option to restore quality of life for patients with disruptive tremor that is not responsive to medications.
Back to being a ham ... operator
Since his MRgHIFU procedure, Mr. Leavell can repair ham radios again with hands as steady as he's ever had. He's also able to work out at the gym and go hunting again – activities he credits to his UT Southwestern care team.
"I'm kind of a smart aleck," Mr. Leavell said, "but through it all, I was optimistic. I wouldn't think twice about getting MRgHIFU done again if I needed it, and I certainly would encourage it for anyone who's considering a procedure to make life more normal for Parkinson's."
UTSW named Parkinson's Center of Excellence
UTSW was recently named a Parkinson's Foundation Center of Excellence, becoming the first in North Texas and only the second in the state. There are only 59 centers worldwide – 46 in the U.S.
The designation was awarded after a rigorous evaluation and peer-review process based on criteria including multidisciplinary Parkinson's disease (PD) care, research, professional education and training, quality improvement, and community outreach. The recognition reflects UTSW's multidisciplinary PD program incorporating Neurology, Neurosurgery, Neuroradiology, Rehabilitation, Psychiatry, Neuropsychology, supportive care services, and community outreach to provide comprehensive care across all stages of the disease.
The PD research program spans basic, translational, and clinical research and clinical trials. The designation includes funding for continued growth and expansion, along with periodic reevaluation to ensure the program continues to meet the standards of a Parkinson's Foundation Center of Excellence.
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