LOCAL TEST CANDIDATE — independent content review pending. Not personal medical advice or a confirmed offer.
DBS care-team roles: Delaram Safarpour at OHSU
Reader question: Who does OHSU name for DBS medical leadership, and does that establish who will operate or program my device?
OHSU’s academic profile names Delaram Safarpour, M.D., M.S.C.E., FAAN, as Associate Professor of Neurology and medical director of its deep brain stimulation programme. It also lists a movement-disorders fellowship at the University of Pennsylvania, completed in 2017.[1] This identifies an institution-reported neurology and medical-leadership role; it is not evidence that she performs DBS implantation or focused-ultrasound surgery, or that she will personally operate on or program the device of this reader.
The profile lists English and Farsi as spoken languages.[1] That may be useful when asking about a consultation, but it does not establish an available appointment, a language-service arrangement or international-patient access.
For programming, the saved OHSU aftercare page describes returning to its clinic about one month after the implanted pulse generator is placed. It says a local neurologist may be able to do some or all programming, that many patients need several sessions usually a month apart, and that later adjustments are typically every six months.[2] These are the programme’s approximate and conditional descriptions, not a schedule for this reader. The page does not name Safarpour as the assigned programmer; medical leadership, surgery and ongoing programming should be confirmed as separate roles.
The saved programme page publishes 503-494-4314 for patient questions, arranging a referral from a neurologist and scheduling follow-up appointments.[2] Use the programme’s official contact route to ask which clinician will do the assessment, which surgeon will operate, who will program the device and which follow-up visits can happen locally. A published contact number is not a confirmed appointment or offer; no message, referral or booking has been sent by this project.
At the profile’s recorded retrieval time, OHSU also displayed an I-5 closure advisory asking visitors to allow extra time to reach the institution.[1] Check the institution’s current directions before travel: this saved advisory is not a fresh road-condition report, personal travel clearance or confirmation of the procedure location.
What remains unconfirmed
- Whether Delaram Safarpour will personally assess this reader, program their device or participate in their specific care; surgical-operator status is NOT established by this profile.
- Individual DBS or focused-ultrasound suitability, clinical recommendation and symptom outcomes.
- Current appointment availability, referral requirements for this reader, international access, language-service arrangements and costs/itemized offer.
- Confirmed treatment room, travel clearance and individualized programming/medicine/device schedule.
- Portrait display/redistribution rights; automated identity-bound discovery on this academic profile returned unresolved.
- Source update dates and current duration of the I-5 advisory; an old saved programme is not a fresh appointment or road-condition confirmation.
A director title and movement-disorders fellowship establish institutional role and training, not performance of a specific operation or personal device-programming assignment. Ask the programme to separately name the proposed surgeon, programmer and follow-up contact. The two pages are from one institution, not independent corroborators; retrieval times are not source update dates.
Next step: Request a written care-team plan that separately names the assessment clinician, surgical operator, device programmer and ongoing-care contact, identifies locally available follow-up and sets out this reader’s referral, language-access, appointment and itemized-cost requirements. Do not infer these assignments from a medical-director title or alter medicines or device settings from this page.
Next question: Which named clinicians will perform surgery, program the device and manage follow-up, and which visits can my local neurologist provide?
Sources for numbered citations
Text citations identify sources; the exact-evidence list below numbers individual passages.
Exact saved evidence
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Delaram Safarpour, M.D., M.S.C.E., FAAN. Associate Professor of Neurology, School of Medicine. Medical director, deep brain stimulation program, OHSU Brain Institute.
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Fellowship. Movement disorders, University of Pennsylvania, 2017.
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Languages spoken: English, Farsi.
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About one month after you have your implanted pulse generator placed, you will return to our clinic so it can be programmed. We will adjust the electrical impulses so they work best to treat your symptoms. Your local neurologist may be able to do some or all of your IPG programming. Many patients need several sessions, usually a month apart, to find the best symptom control. After that, the IPG is typically adjusted every six months.
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For patients. Call 503-494-4314 to: Ask questions. Arrange a referral from your neurologist. Schedule follow-up appointments.
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I-5 closure underway. Plan extra time to reach OHSU. Details on I-5 construction.
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Institution-reported programme information. Retrieval time is not an update date or appointment confirmation.
Media still needed
- Identity-supported usable clinician portrait: Named image metadata is observed in saved academic HTML, but existing automatic discovery is unresolved; candidate-specific display rights are not established and no image is embedded.
Previously reviewed ongoing-care, assessment, staged-treatment, surgical-operator and travel results
LOCAL TEST CANDIDATE — independent content review pending. Not personal medical advice or a confirmed offer.
Choosing DBS for tremor: plan for programming and ongoing device care
Reader question: If I choose DBS for tremor, what ongoing programming, battery care and coordination should I plan for after surgery?
DBS is not a one-time cure. OHSU says deep brain stimulation does not cure Parkinson's disease or essential tremor and does not slow their progression; settings can be adjusted to help control symptoms as the disease progresses.[2] This section explains OHSU's published ongoing-care pathway, not whether DBS is suitable for you or better than focused ultrasound.
Plan for programming visits after implantation. An implanted pulse generator (IPG) is the device whose stimulation settings are programmed. OHSU describes a first programming visit about one month after IPG placement, with several sessions often needed, usually a month apart, to find the best symptom control. After that, the IPG is typically adjusted every six months.[1] These are OHSU's approximate timings, not confirmed appointments or a universal schedule. The page says a local neurologist may be able to do some or all programming.[1] Before arranging care away from home, confirm who can program your particular system and how that clinician will coordinate with the implanting team; local or remote programming is not assured.
Separate battery replacement from recharging. OHSU says it replaces the battery in the generator every three to five years in a minor outpatient procedure, and that newer rechargeable generators last about 15 years before replacement.[1] These are the institution's estimates, not a guarantee for your device. 'About 15 years' describes generator replacement, not how long one charge lasts. The saved pages do not establish your model's recharge frequency, battery-alert response or replacement date: ask for the instructions for your exact implant.
A patient programmer does not mean unrestricted self-adjustment. OHSU says the handheld programmer lets a patient turn the IPG on or off and check the battery level; only depending on the specific case may it also allow minor adjustments.[2] Ask the team to explain which functions and setting range are permitted for you. Do not treat that general description as instructions to change settings or switch the system off for a procedure.
Follow-up includes side effects and changing symptoms, not just the battery. OHSU says some patients have speech or balance problems and that a DBS programmer or neurologist can adjust the IPG to reduce or stop side effects. It also notes that symptoms may change or worsen with disease progression and stresses continuing physical and speech therapy after surgery.[2] Adjustment is not a promise that every problem will resolve. Ask your treating team what follow-up and rehabilitation you need and whom to contact about new difficulties.
Medication expectations differ by diagnosis. OHSU's FAQ says Parkinson's disease patients will not stop medication, although the amount may be reduced with a neurologist's guidance; essential tremor patients may be able to reduce or stop many or all tremor medicines.[2] 'May' is not a promise that you will stop treatment. Confirm your own medicine plan with your neurologist rather than reducing or stopping medicines because DBS has been implanted.
Tell clinicians about the implant before an MRI, other tests or surgery. OHSU warns that certain procedures can affect the DBS system or cause health issues, gives MRI as an example that can damage the system, and discusses clinician setting adjustments for MRI and turning the system off during surgery.[2] This broad FAQ is not device-specific MRI clearance or a self-directed switch-off plan. Have the DBS team and the team performing the procedure confirm the requirements for your exact implanted system before proceeding.
For OHSU-specific questions, its aftercare page lists 503-494-4314 for questions, a referral from your neurologist and follow-up scheduling.[1] That is a published contact route, not a confirmed booking, coverage decision or international-patient arrangement. Ask about programming and device-maintenance availability near home, the division of responsibility between clinicians, and any costs not included in a surgical quote. No programming, replacement, travel or package price is established by these saved pages.
What remains unconfirmed
- Your diagnosis, suitability for DBS, personal benefit, prescribed settings, medication plan and follow-up dates are not established.
- Your exact generator model, replacement interval, recharge frequency, battery-alert response and allowed patient setting range need confirmation with your DBS team; no charging manual has been assessed.
- Whether a neurologist near home can program your particular system and coordinate with the implanting centre is unconfirmed; neither remote programming nor all-local follow-up is promised.
- MRI and other procedure safety for your exact implanted system require device-specific and clinical assessment. These pages are not a complete manufacturer safety label or personal MRI clearance.
- Programming, replacement, travel and follow-up prices, coverage, appointment availability and package inclusions remain unknown; no comparative cost or treatment ranking is supported.
- No explicit clinical update date was established for these saved pages; retrieval timestamps and copyright are not update dates.
Two patient-information pages from the SAME institution describe an example pathway, not independently corroborated device specifications or a universal care schedule. No exact implant model, recharge frequency, battery check schedule, personal setting range, MRI conditions, update date or cost is established. Published battery lifetimes are OHSU estimates, not warranties. The FAQ's MRI wording does not qualify any particular device for scanning; do not turn it into a do-it-yourself clearance or switch-off instruction.
Next step: Before committing to DBS or travel, ask the implanting team for a written ongoing-care plan: the exact system, who will program it locally, expected review visits, permitted programmer functions, charging and battery-alert instructions, replacement planning, medication and rehabilitation decisions, and coordination before future scans or surgery. Confirm the costs and availability separately. This section does not authorize changing medicines, stimulation settings or MRI arrangements.
Next question: Who will program and monitor my specific DBS system near home, what are its charging and replacement requirements, and how will medicines and future scans or surgery be coordinated?
Sources for numbered citations
Text citations identify sources; the exact-evidence list below numbers individual passages.
- [1] What to Expect After DBS Surgery | OHSU
- [2] DBS: Frequently Asked Questions and Resources | Brain Institute | OHSU
Exact saved evidence
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DBS won’t cure Parkinson’s disease or essential tremor, and it won’t slow the progression of either disease. The stimulator settings can be adjusted, however, to better control symptoms as your disease progresses.
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About one month after you have your implanted pulse generator placed, you will return to our clinic so it can be programmed. We will adjust the electrical impulses so they work best to treat your symptoms. Your local neurologist may be able to do some or all of your IPG programming. Many patients need several sessions, usually a month apart, to find the best symptom control. After that, the IPG is typically adjusted every six months.
Official programme source — saved 2026-10-06T21:24:06.267683+00:00; text characters 2808–3245
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We replace the battery in the generator every three to five years in a minor outpatient procedure. Newer rechargeable generators last about 15 years before they need replacement.
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You will get a programmer that allows you to turn your IPG on or off and check the battery level. Depending on your specific case, the programmer may let you make minor adjustments yourself.
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There can be. Many patients have no long-term side effects. Some have speech or balance problems. A DBS programmer or neurologist can adjust your IPG to reduce or stop side effects. Keep in mind that DBS is not a cure. Your symptoms may change or get worse over time as your disease progresses. It is important to continue with physical and speech therapy even after DBS surgery.
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Parkinson's disease patients will not stop taking medication. They may reduce the amount of medication, with their neurologist’s guidance. Essential tremor patients may be able to reduce or stop many or all tremor medications.
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Certain procedures can affect the DBS system, or cause potential health issues. For example, MRI (magnetic resonance imaging) can damage the DBS system. Your neurologist can adjust your DBS settings if you need an MRI. You'll also want the system turned off during surgery. Make sure you tell your health care provider that you have a neurostimulation system.
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Call 503-494-4314 to: Ask questions. Arrange a referral from your neurologist. Schedule follow-up appointments.
Official programme source — saved 2026-10-06T21:24:06.267683+00:00; text characters 4318–4429
Institution-reported programme information. Retrieval time is not an update date or appointment confirmation.
Media still needed
- A clear DBS ongoing-care timeline showing programming and later device maintenance separately: No source-qualified illustration for this new section has been independently reviewed; no manufacturer diagram or unlicensed image is embedded.
Previously reviewed focused-ultrasound assessment, staged-treatment answer, doctor and travel results
LOCAL TEST CANDIDATE — independent content review pending. Not personal medical advice or a confirmed offer.
Before focused ultrasound for essential tremor: assessment is not a treatment approval
Reader question: What assessment is needed before MR-guided focused ultrasound for essential tremor, and what can prevent treatment?
Start with a specialist assessment, not a booking based on a checklist. OHSU describes a confirmed diagnosis of medication-unresponsive tremor affecting quality of life.[1] Stanford's possible-candidate wording includes medicines that did not work, stopped working or caused intolerable side effects, and also not wanting medication.[2] Those statements are not identical: declining medicine alone does not establish your eligibility at OHSU or any other centre.
What is assessed before treatment? OHSU specifies a meeting with a neurosurgeon and patient coordinator to discuss benefits and risks, plus an MRI and a CT scan.[1] UCLH describes an initial screening consultation, followed when appropriate by investigations that may include a formal tremor-severity assessment, brain and skull imaging, blood tests and neuropsychology tests; the team then reviews the results and compares treatment options for your situation.[3] The word 'may' matters: this is not proof that every test is required for every patient at every centre.
Why the CT scan? Stanford says it uses head CT to calculate skull density ratio (SDR), an estimate of whether ultrasound can pass through the skull to reach the brain target.[2] UCLH explains that some people's skull anatomy prevents effective transmission and that CT can establish this.[3] Skull suitability can therefore prevent treatment, but these pages do not establish a universal numerical SDR cutoff or show whether your own skull is suitable.
What else needs individual review? UCLH says dementia, significant memory impairment or mental disorders may make someone unsuitable, and pre-existing balance or speech problems may become worse after thalamotomy.[3] Its page states that permanent brain implants, such as stimulators or aneurysm clips, or a cardiac pacemaker prevent treatment in its described pathway.[3] Ask the treating team about MRI suitability and its policy for your exact device rather than applying that statement as a universal rule. UCLH also says awake interaction with the team is important and describes a typical three-to-four-hour procedure.[3] Discuss whether positioning and communication would be manageable for you; that published duration is not a promise about another centre.
Medicines need a personal plan, not a self-directed pause. UCLH publishes restrictions on blood thinners such as warfarin or apixaban and a one-week-before-and-after instruction for aspirin and anti-inflammatory painkillers; it tells patients to check with the team when unsure about medicines.[3] OHSU's focused-ultrasound comparison instead refers to stopping blood thinners for 'a few days'.[1] These are different published instructions, not an agreed schedule for your medicine. Do not stop or restart a medicine on the basis of this block: obtain a written plan from the treating team and the clinician who prescribes it, and ask whether a safe plan is possible before treatment is scheduled.
The decision comes after the work-up. UCLH describes reviewing test results and explaining the advantages and disadvantages of surgical options as they apply to you.[3] Its page is labelled last updated 18 June 2026, with review due 1 July 2028.[3] The saved versions of all three pages are linked below; the time Hub retrieved a page is not its clinical update date. This is a preparation guide from centre-reported information, not a complete device contraindication list, personal treatment approval, second-side approval, confirmed offer or travel clearance.
What remains unconfirmed
- Your confirmed diagnosis, symptom severity, treatment history, scan results and individual eligibility are unknown.
- No complete device-specific contraindication list or universal SDR cutoff is established by these three patient pages.
- MRI suitability and the treating centre's policy for your exact implant, medical conditions, positioning tolerance and communication needs require individual assessment.
- A safe stop/restart plan for any blood thinner or other medicine is not established here; obtain instructions from the treating team and the prescribing clinician, rather than changing medicines yourself.
- The number of required medicine trials, exact tests, referral process, appointment availability, cost and coverage at your chosen centre are unconfirmed.
- This first-procedure work-up does not establish second-side candidacy, a booking or travel clearance.
These are three centres' patient-information pages, not a complete current device label or an individual assessment. Their selection wording differs: OHSU describes confirmed medication-unresponsive tremor, whereas Stanford also mentions not wanting medication. UCLH's implant restrictions and medication instructions must not be presented as universal rules for every centre. No numerical SDR cutoff or self-directed medicine interruption is inferred.
Next step: Prepare your diagnosis and previous treatment details, medicine list and implant information for the specialist consultation. Ask which scans and tests are required, what your CT/MRI findings mean, whether any restriction applies to you, how medicines will be managed, and which alternatives remain if focused ultrasound is unsuitable. Obtain a centre-specific decision before making treatment or travel commitments.
Next question: Which assessments and centre-specific restrictions apply to my diagnosis, CT/MRI findings, implant details and medicines, and what alternatives remain if MRgFUS is unsuitable?
Sources for numbered citations
The source numbers in the text identify centres; the exact-evidence list below numbers individual passages.
- [1] OHSU
- [2] Stanford Health Care
- [3] UCLH
Exact saved evidence
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If your tremor is affecting your quality of life and medication isn’t helping, focused ultrasound may be an option for you. This treatment works for patients who: Have a confirmed diagnosis of essential tremor or Parkinson’s-related tremor that does not respond to medication (such as propranolol or primidone).
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You’ll meet with one of our neurosurgeons and our patient coordinator to discuss the benefits and risks. We will assess your condition to make sure focused ultrasound is right for you. You’ll need an MRI and a CT scan.
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We will first do a CT scan of your head to calculate your skull density ratio (SDR), a number that estimates whether ultrasound can penetrate your skull to reach the target in your brain.
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You may be a good candidate for MRgFUS to treat tremor related to essential tremor or Parkinson’s disease if you have: A skull suitable for ultrasound treatment, as measured by SDR. Symptoms resistant to other medical treatment, such as if medications didn’t work, stopped working, or led to intolerable side effects, or if you don’t want to take medications.
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Certain criteria may make you unsuitable for Focused Ultrasound, such as a diagnosis of dementia, significant memory impairment or mental disorders. Pre-existing problems with balance or speech may become worse after Focused Ultrasound thalamotomy. In some people, the anatomy of the skull prevents the ultrasound effectively reaching the brain. A CT scan of the skull will be obtained before the procedure and can establish if this is the case. If you have any permanent brain implants (e.g.: stimulator devices or aneurysm clips) or a cardiac pacemaker, it will not be possible to perform Focused Ultrasound thalamotomy.
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The first appointment is an initial screening consultation and can be via video- consultation or face-to-face. If Focused Ultrasound thalamotomy should be considered, several investigations will be organised and may include formal assessment of tremor severity, brain and skull imaging, blood tests and neuropsychology tests. At the next consultation you will meet members of the team that will review you and your test results. They will explain the advantages and disadvantages of the various surgical treatments for tremor, including Focused Ultrasound thalamotomy, and how they pertain to your specific situation.
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Patients undergoing Focused Ultrasound thalamotomy should not be taking medications that thin the blood such as warfarin or apixaban. You should avoid taking Aspirin and non-steroidal anti-inflammatory drugs (such as Ibuprofen or diclofenac) for a week prior to and following surgery to reduce the risk of bleeding. You should continue taking your other medications as normal unless the team tells you otherwise. If you are unsure whether you should take a new type of medicine, please contact us before you do so.
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It is important that you are awake so that you can interact with the team and help them optimise the treatment.
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A typical focused ultrasound thalamotomy takes three to four hours and requires between 10 and 20 ultrasound treatments.
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If you take blood thinners, you need to stop taking them for a few days.
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Page last updated: 18 June 2026. Review due: 01 July 2028.
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Institution-reported programme information. Retrieval time is not an update date or appointment confirmation.
Media still needed
- An assessment-pathway illustration separating specialist consultation, scans and team decision: No independently qualified explanatory illustration has been created for this new block; no unlicensed portrait or invented diagnostic diagram is embedded.
Previously reviewed staged-treatment answer, doctor and travel results
LOCAL TEST CANDIDATE — independent content review pending. Not personal medical advice or a confirmed offer.
OHSU's one-side comparison does not settle the staged-treatment question
Reader question: OHSU's programme describes staged bilateral focused ultrasound but its comparison says one side only: what does this mean for someone with essential tremor?
Read OHSU's programme as describing a staged pathway, not two sides treated together. Its opening says it can treat both sides, one side at a time, with at least nine months between sides. However, its comparison with deep brain stimulation (DBS) still says focused ultrasound can only treat one side. That chart explicitly covers essential tremor and tremor-dominant Parkinson's disease. These statements are inconsistent at face value; the one-side cell alone should not be treated as proof that OHSU never offers a second-stage procedure.
Dated context supports a second-side pathway for selected essential-tremor patients, not automatic eligibility. In its 12 September 2023 CE-mark announcement, manufacturer Insightec says the approval followed US FDA approval in December 2022 and describes a second side at least nine months after the first for qualifying patients. This is a manufacturer account of the approval context, not the complete regulatory label or confirmation of an individual OHSU plan. It does not establish when OHSU changed either section of its page.
Three explanations remain possible: an outdated comparison cell, shorthand for treating one side per session, or an intended distinction between diagnoses or brain targets. None is confirmed by the saved page. OHSU's 28 October 2025 news describes a different focal target for a Parkinson's intervention than for essential tremor, within the pallidothalamic tract. That helps distinguish procedures but does not explain the comparison cell; do not transfer an essential-tremor staged pathway to every Parkinson's intervention. The opening's one-side-at-a-time wording makes the per-session reading possible, but the table itself does not say per session.
For someone with essential tremor, the practical next step is a diagnosis-specific assessment, not a decision based on that single table cell. OHSU describes discussing benefits and risks with a neurosurgeon and patient coordinator, an assessment, and MRI plus CT. Ask which brain target and side are proposed, whether a second-side stage could be considered after reassessment, and how the team explains the conflicting wording. The stated nine-month interval is a minimum separation in the programme description, not a guarantee that a second procedure will be appropriate or available for you.
What remains unconfirmed
- OHSU's intended meaning and revision date for the one-side-only comparison cell; whether it is outdated or shorthand for one session
- the patient's confirmed diagnosis, proposed brain target, clinical eligibility and whether a second-side procedure would be offered after reassessment
- the programme's individual second-stage criteria, residual-symptom assessment, risks and follow-up plan; nine months is not automatic clearance
- current appointment availability, international access, payment or insurance coverage and any confirmed treatment package
No section-specific update history or OHSU clarification was obtained. The inconsistency cannot be definitively attributed to stale editing, per-session shorthand or diagnostic scope. Preserve both statements, attribute the dated announcement to the manufacturer, and obtain a written diagnosis-specific plan from the treating team; this is not individual medical advice or a booked offer.
Next step: Request a written essential-tremor plan from OHSU's treating team covering the proposed target and first side, second-side reassessment criteria and minimum interval, individual risks and follow-up, plus clarification of the one-side-only comparison. Do not treat the page, announcement or this explanation as personal eligibility, a confirmed appointment or a treatment package.
Next question: What diagnosis-specific target and second-side reassessment criteria does OHSU currently apply, and how does its team explain the one-side-only comparison cell?
Exact saved evidence
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We can treat both sides of your body with bilateral focused ultrasound. You’ll have one side treated at a time, with at least nine months between sides.
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This chart compares the two treatment options we offer for essential tremor and tremor-dominant Parkinson’s disease.
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Can only treat one side.
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You’ll meet with one of our neurosurgeons and our patient coordinator to discuss the benefits and risks. We will assess your condition to make sure focused ultrasound is right for you. You’ll need an MRI and a CT scan.
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CE mark approval follows the US FDA approval from December 2022. Treatment can enable qualifying patients to have their second side treated at least nine months after first side.
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MÜNCHEN, Germany, 12 September 2023
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Essential tremor commonly affects both sides of the body, and this new CE mark approval will allow appropriate patients to have their second side treated at least nine months after treatment of the first side, potentially meaning tremor relief on both sides of the body.
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By Erik Robinson October 28, 2025 Portland, Oregon.
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Guided in real time by magnetic resonance imaging, known as MRI, the neurosurgeon precisely targets a focal point that’s slightly different in Parkinson’s than in essential tremor, zeroing in an area within the pallidothalamic tract of the brain.
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Institution-reported programme information. Retrieval time is not an update date or appointment confirmation.
Media still needed
- source-bound staged-course illustration: A clinically reviewed visual showing separate stages and reassessment is not assigned; nine-month spacing must not be depicted as automatic eligibility.
Previously reviewed doctor, travel and follow-up results
LOCAL TEST CANDIDATE — independent content review pending. Not a provider recommendation.
Who is documented as performing the procedure, and where?
Ahmed M. Raslan
- Documented role
- OHSU neurosurgeon; profile lists Chair, Neurological Surgery, School of Medicine
- Programme and location distinction
- OHSU HIFU; provider profile lists Neurosurgery Clinic, South Waterfront for patient contact, not a confirmed procedure location
Evidence ceiling: OHSU's saved provider profile identifies Ahmed M. Raslan as a neurosurgeon and explicitly includes high-intensity focused ultrasound for essential tremor and Parkinson’s disease among surgeries he performs. The saved programme independently describes OHSU HIFU. The profile lists OHSU Neurosurgery Clinic, South Waterfront as a patient-contact/clinic location; this is NOT confirmation of the actual focused-ultrasound treatment room, personal operator assignment, eligibility, international access, appointment, price or package. Institution-reported evidence only, no outcome ranking or recommendation. A source-bound headshot candidate may be investigated separately; no redistribution/display right is established by the clinical profile.
What the hospital source actually says
- identity: Ahmed M. Raslan, M.D., FAANS. Accepting new patients. Chair, Neurological Surgery, School of Medicine. (saved source text characters 2472–2574) Source
- current role: Ahmed M. Raslan, M.D., FAANS. Accepting new patients. Chair, Neurological Surgery, School of Medicine. (saved source text characters 2472–2574) Source
- procedure: Ahmed M. Raslan, M.D., FAANS. Accepting new patients. Chair, Neurological Surgery, School of Medicine. Specialty. Neurological Surgery. Clinical focus. Brain and Spinal Cord Cancer. Chronic Pain. Epilepsy. High-Intensity Focused Ultrasound (HIFU). Neuro-Oncology. Neuroscience. Parkinson's and Movement Disorders. Schedule online. Email this page. Print this page. Locations and contact. I see patients at. Locate. Center for Health & Healing, Building 1. 503-494-8311. Read clinic details. 1 OHSU Neurosurgery Clinic, South Waterfront. 3303 S. Bond Avenue eighth floor. Portland , OR 97239. 503-494-4314. Physician Advice and Referral Service. About me. Dr. Raslan is a neurosurgeon who cares for adult patients with epilepsy, brain tumors, hydrocephalus and movement disorders. He also treats patients who have chronic pain , such as facial and spinal pain and pain from cancer. Some of the surgeries he performs include brain mapping and awake craniotomy for epilepsy and brain tumors; high-intensity focused ultrasound (HIFU) for essential tremor and Parkinson’s disease; and deep brain stimulation for epilepsy and movement disorders. (saved source text characters 2472–3611) Source
- programme: Locations and contact. I see patients at. Locate. Center for Health & Healing, Building 1. 503-494-8311. Read clinic details. 1 OHSU Neurosurgery Clinic, South Waterfront. 3303 S. Bond Avenue eighth floor. Portland , OR 97239. (saved source text characters 2837–3063) Source
- Official hospital programme source — saved 2026-10-06T14:08:39.786117+00:00
Institution-reported evidence; not an independent performance ranking. Retrieval date is not the hospital’s last-update date.
Still unknown
- individual eligibility
- current appointment availability
- individual treatment recommendation
- personal procedure volume
- price, package inclusions and international access
- usable portrait with provenance and use restrictions
Next useful question: Ask the programme to confirm the proposed operator, treatment site, eligibility evaluation, international access and an itemized offer before choosing a route. A clinic catalogue link is not a confirmed offer.
This profile came from saved doctor_verify → profile_compile → option_match outputs. The historical trial does not determine an individual’s suitability or verify this provider’s outcomes.
Previously reviewed travel and follow-up result
LOCAL TEST CANDIDATE — independent content review pending. Not personal medical advice or a confirmed offer.
Going home that day does not confirm your travel date
Reader question: What should I confirm about travel timing when a focused-ultrasound programme says I can go home the same day?
Keep discharge and departure separate. OHSU’s saved focused-ultrasound page says patients go home on treatment day and return the next day for an MRI. It also describes possible swelling in the treatment area for two to three weeks, which could cause imbalance or instability in the dominant leg. That programme description does not say when an individual can safely leave the destination or fly; ask the treating team to specify your follow-up and departure requirements.
Confirm who will help after treatment. RUSH lists a good support system at home for care after the procedure among its criteria. Ask the programme what support and companion arrangements it requires in your situation, where follow-up will occur and how you will reach the team after returning home. Do not treat either institution’s page as confirmation of personal eligibility or a booked travel package.
What remains unconfirmed
- your individual safe departure or flight date
- required local stay and companion support
- follow-up locations, timing and remote aftercare arrangements
- confirmed eligibility and booking, international access and itemized costs
These programme descriptions do not establish that you are eligible, have a confirmed treatment booking, or can safely fly on any particular day. Possible symptoms and follow-up requirements are institution-reported examples, not predictions for an individual or a cross-provider recovery guarantee.
Next step: Before booking travel, request a written, individual plan for the required local stay, companion support, follow-up and team-cleared departure. Confirm the treatment booking and costs separately.
Next question: What local stay, companion arrangements and follow-up must be completed before my treating team clears departure?
Exact saved evidence
-
You go home that day. You return the next day for an MRI to evaluate the lesion and any swelling from excess fluid. You may have brain swelling in the treatment area for two to three weeks. This could cause imbalance or some instability in your dominant (stronger) leg.
Official programme source — saved 2026-10-06T11:14:20.304976+00:00; text characters 5217–5486
-
You must have a good support system at home for care after the procedure.
Official programme source — saved 2026-10-06T11:13:19.795780+00:00; text characters 7287–7360
Institution-reported programme information. Retrieval time is not an update date or appointment confirmation.
Media still needed
- procedure-day → next-day follow-up → team-cleared departure timeline: No independently checked visual has been assigned; an invented travel-clearance date must not be drawn.
Focused ultrasound for essential tremor: evidence, risks and programs
An incision-free procedure still makes a permanent change in the brain. This guide separates what trials measured from what hospitals advertise, and what is documented from what you still need to ask. It is a research draft, not a personal treatment recommendation.
What the procedure actually does
source-supported draft
MR-guided focused ultrasound (MRgFUS) combines MRI with focused sound energy to target and ablate tremor-related cells in the ventral intermediate nucleus of the thalamus. This page concerns thalamotomy for essential tremor, not every procedure called HIFU.[3]
The treatment creates a permanent ablation, rather than an implanted stimulator that can be reprogrammed. In the bilateral trial, the team increased energy only after checking for tremor improvement and unwanted effects.[13]
Who may be assessed
source-supported draft
UVA’s published screening criteria include a confirmed diagnosis, tremor that has not improved with medication such as propranolol or primidone, severity sufficient to consider a procedure, and interference with daily activities. These are reasons for assessment, not an online eligibility decision.[8]
UVA says potential candidates need a special CT scan as part of evaluation, and warns that anxiety or claustrophobia may make its 2–3 hour procedure difficult to tolerate.[8]
The 2016 randomized trial enrolled people with moderate-to-severe essential tremor that had not responded to at least two trials of medical therapy; assignment was 3:1 to unilateral MRgFUS or a sham procedure.[11]
NICE says selection should be by a multidisciplinary team experienced in essential tremor, including clinicians specifically trained in this procedure.[16]
A specialist needs to confirm the cause of tremor and assess your goals. This page cannot decide whether treatment is suitable for you.
Limits: one side, two sides and selection
source-supported draft
Penn’s January 2023 briefing describes unilateral MRgFUS and staged bilateral procedures, with treatment of the second side at least 9 months later. Bilateral does not mean both sides are treated in one session, or that everyone qualifies for the second procedure.[3]
The 2024 second-side trial excluded persistent neurological worsening after the first procedure, clinically significant speech problems and specified swallowing, cognitive and other medical concerns. Do not extend its results to everyone with bilateral tremor.[13]
Treatment may not work, and benefit may wear off with time. Immediate improvement should not be presented as a cure or a guarantee of permanent symptom relief.[8]
A second-side decision deserves a separate assessment of speech, swallowing, coordination and the effects of the first procedure. Trial exclusion criteria are not a self-screening checklist.
Alternatives and tradeoffs—not a winner
source-supported draft
Penn’s clinical briefing identifies propranolol and primidone as first-line medicines and notes that adverse effects or insufficient benefit can limit them. Reviewing prior medication response with a specialist is an alternative to assuming a procedure is the next step.[3]
Deep brain stimulation (DBS) is an established alternative for refractory essential tremor. Its stimulation can be adjusted to seek more benefit and reduce off-target effects; that adjustability differs from creating an ablation.[13]
MRgFUS avoids hardware implants. That is a practical difference from DBS, not evidence that it is the safer or more effective option for a particular person.[13]
This is a focused comparison of the main options supported by this source set, not an exhaustive review of all tremor treatments. Ask the team about other treatments if these options do not fit your situation.
| Option | Documented distinction | Question for the specialist |
|---|---|---|
| Medication review | Propranolol and primidone are first-line examples.[3] | Have adequate options been tried, and what limited their use? |
| MRgFUS thalamotomy | Permanent ablation; no hardware implant. Second-side treatment is a separate staged decision.[13][3] | How do treatment side, balance, speech and swallowing affect my suitability? |
| Deep brain stimulation | Adjustable stimulation for refractory essential tremor.[13] | What implanted-device care and follow-up would I need, and how do its risks compare in my case? |
What studies measured
source-supported draft
In the 2016 trial, hand-tremor scores changed from 18.1 to 9.6 with treatment and from 16.0 to 15.8 with sham at 3 months. The between-group difference in mean change was 8.3 points (95% CI 5.9–10.7), on a 32-point scale where higher scores mean worse tremor.[11]
Among 40 people who completed the 5-year follow-up, treated-hand postural tremor scores were 73.1% better than baseline; combined hand tremor/motor scores were 40.4% better. These measure different things. Neither number is a percentage of patients cured or a clinic success rate.[6]
The 2024 staged bilateral study was an open-label, uncontrolled multicenter cohort, not a sham-controlled trial. Of 62 recruited after a previous unilateral procedure, 51 received second-side treatment; 50 completed the 3-month assessment and 48 completed 12 months.[13]
The mean treated-side tremor/motor score fell from 17.4 to 6.4 at 3 months after the second procedure: a reported 66% improvement (95% CI 59.8–72.2). The study’s selection and lack of a control group limit generalization; this is not a head-to-head result against DBS or unilateral treatment.[13]
Do not compare the percentages as though they measure the same outcome in the same patients. The studies differ in treatment side, selection, follow-up and design. The five-year abstract gives outcomes in completers; it does not establish everyone’s chance of maintaining benefit.
Risks and evidence limitations
source-supported draft
In the 2016 trial’s treatment group, gait disturbance occurred in 36% and numbness or paresthesias in 38%; these persisted at 12 months in 9% and 14%, respectively. Incision-free does not mean free of lasting neurological risks.[11]
The staged bilateral trial reported persistent numbness/tingling in 8 participants, dysarthria (speech difficulty) in 7, and ataxia (coordination difficulty) in 6 at 12 months. Most reported events were mild, but persistent symptoms still matter when weighing a second procedure.[13]
The full report also records moderate swallowing difficulty and taste disturbance at 12 months in one participant each, plus a severe urinary tract infection attributed to catheter use during treatment. A summary saying all side effects are mild or temporary would be wrong.[13]
The staged bilateral study was funded by Insightec, the device manufacturer. Funding is relevant context, not by itself a reason to discard the study.[13]
The 12-month adverse-event table: n=47. This is distinct from the 48 people reported as completing the 12-month visit; do not silently use the visit count as the safety denominator.[13]
This source set does not provide individualized complication estimates. Ask the treating team to explain how existing balance, speech or swallowing problems affect the options. Primary abstracts were read for the 2016 and five-year studies; the 2024 bilateral full text was also read.
During treatment
source-supported draft
During Penn’s described procedure you are awake and responsive. A head frame limits movement. The team applies sound energy in increasing steps, monitors temperature with MRI, and checks tremor response after each step.[3]
The patient remains awake and responsive during the MRgFUS procedure described by Penn.[3]
Penn describes a spiral-drawing assessment and a stabilizing head frame.[3]
Ask the center how it keeps you comfortable, how you communicate during scanning, and what would cause it to stop or postpone treatment.
Preparing for a consultation and procedure
partial: center instructions required
UVA says potential candidates need a special CT scan as part of evaluation, and warns that anxiety or claustrophobia may make its 2–3 hour procedure difficult to tolerate.[8]
Penn describes a spiral-drawing assessment and a stabilizing head frame.[3]
For a consultation, prepare a list of prior tremor treatments and their effects, your current medicines, relevant diagnoses, any implants, and what daily tasks you want to improve. Ask which records or scans the center needs before booking travel.
No fasting, medication-withholding or anticoagulant instructions are provided here. Obtain a written plan from the treating team; do not change prescribed medicines based on this page.
Recovery and travel planning
partial: travel clearance unknown
Penn’s briefing describes short observation followed by going home, with return to daily activities within a day or so. This is its published general pathway, not a promise of next-day travel or fitness to drive.[3]
Imperial Private Care describes local anaesthesia, a one-night hospital stay, possible balance issues for about a month, and advice not to drive for one month. Do not substitute Penn’s next-day activity description for these instructions.[1]
Treatment may not work, and benefit may wear off with time. Immediate improvement should not be presented as a cure or a guarantee of permanent symptom relief.[8]
These different published pathways are a reason to ask questions, not a reason to pick the shortest stay. Before paying for travel, ask about an accompanying adult, local accommodation, return-to-work and driving restrictions, fitness to fly, and who manages new symptoms or persistent side effects after you return home.
Named clinicians: what is actually verified
partial: expertise metrics unavailable
Penn’s procedure-specific faculty list names Iahn Cajigas, MD, PhD, and Casey H. Halpern, MD as providing focused ultrasound therapy for essential tremor. This is practice evidence, not an inference from paper authorship.[3]
Casey H. Halpern’s Penn profile identifies him as Division Head of Functional and Stereotactic Neurosurgery and Professor of Neurosurgery; its treatment list includes MR-guided focused ultrasound and DBS.[4]
Imperial’s procedure page names Professor Dipankar Nandi, Dr Peter Bain and Professor Wladislaw Gedroyc as the treating team. Its claim to be the UK’s most experienced team is not independently substantiated here and is not used for ranking.[1]
UVA’s Jeff Elias profile describes his directorship of Stereotactic and Functional Neurosurgery; it lists essential tremor, focused ultrasound and thalamotomy among conditions and treatments. This supports a clinical program relationship, not a guarantee that he will personally perform an offered procedure.[14]
No named clinician is endorsed or ranked. Provider profiles establish institutional roles and listed practice; they do not establish audited procedure volume, complication rates or superiority. Photos are not copied, and a study author is not automatically treated as a current operator.
| Named clinician | Program and evidence |
|---|---|
| Casey H. Halpern, MD | Penn Medicine[3][4] |
| Iahn Cajigas, MD, PhD | Penn Medicine[3] |
| Jeff Elias, MD | UVA Health[14] |
| Professor Dipankar Nandi | Imperial College Healthcare Private Care[1] |
| Dr Peter Bain | Imperial College Healthcare Private Care[1] |
| Professor Wladislaw Gedroyc | Imperial College Healthcare Private Care[1] |
Compare documented programs
partial: current availability unconfirmed
Imperial identifies The Lindo Wing of St Mary’s as the treatment site in its published description; confirm the location for any proposed appointment.[17]
These are public program descriptions, not purchasable packages. Penn, UVA, Imperial and Queen Square have source-supported procedure links and distinct pathways. No clinical quality ranking, assigned operator or treatment slot is established.
| Decision point | Penn Medicine | UVA Health | Imperial College Healthcare Private Care | Queen Square Imaging Centre |
|---|---|---|---|---|
| Procedure and clinical link | MRgFUS for essential tremor; named neurosurgical faculty.[3] | Essential-tremor program; Jeff Elias’s profile lists focused ultrasound.[8][14] | MR-guided focused ultrasound; Nandi, Bain and Gedroyc named as treating team.[1] | Staged MRgFUS essential-tremor pathway; no named assigned clinician verified.[18] |
| One side or second side | 2023 briefing describes staged second-side treatment at least 9 months later; current individual eligibility unconfirmed.[3] | Current second-side pathway not established by the selected program body. | Current second-side pathway not established by the selected program body. | Second-side authorization and criteria not established; conflicting provider wording needs dated clarification. |
| Documented assessment detail | Tremor assessment with a spiral-drawing test is described; obtain the complete current screening protocol.[3] | Confirmed diagnosis, medication failure and daily-function impact; CT screening and tolerance of 2–3 hours emphasized.[8] | Detailed eligibility and screening checklist not established from this body. | MDT assessment, MRI, skull CT and blood tests when considered appropriate.[18] |
| Published stay / recovery pathway | Short observation, then home; ordinary activities within a day or so in its 2023 description. Not flight or driving clearance.[3] | No specific stay or travel-clearance plan verified in the selected evidence. | One night in hospital; advice not to drive for one month; possible balance issues during that period.[1] | Published day-case pathway and local hotel arrangement; cost inclusion and travel clearance not established.[18] |
| Price and availability | No dated quote or treatment slot verified. | No dated quote or treatment slot verified. | No dated quote or treatment slot verified. | UK-resident published fees are shown by stage below; no individual quote or treatment slot verified.[18] |
| Published aftercare included in the treatment package | Not established in the selected public evidence. | Not established in the selected public evidence. | Not established in the selected public evidence. | Scheduled follow-up over one year, including the six-month MRI, is included. Unexpected medicines or diagnostic tests arranged privately may cost extra; UK-resident fee scope applies and international patients need a bespoke quotation.[19][18] |
Penn Medicine
Ask next: Does the team currently offer second-side assessment in my circumstances, and what local stay and follow-up are required?
Visit the official program information — no enquiry is sent from this page.
UVA Health
Ask next: What CT and clinical screening are needed, and is a one-side or second-side pathway available for me?
Visit the official program information — no enquiry is sent from this page.
Imperial College Healthcare Private Care
Ask next: Are the listed team and overnight pathway current, and what restrictions and funding route apply?
Visit the official program information — no enquiry is sent from this page.
Queen Square Imaging Centre
Ask next: Do the UK-resident published fees apply to me, what additional costs are possible, and can you provide an itemized current quote? Second-side eligibility needs separate dated confirmation.
Visit the official program information — no enquiry is sent from this page.
Prices and what an offer must include
partial: published stages for one provider; comparable individual quotes missing
Queen Square provides UK-resident published stage fees, qualified below. These are not a dated individualized quote. Other programs still lack verified fees; international prices and cross-provider comparable offers remain open.
Request a written quote separating consultation, CT/MRI screening, procedure and professional fees, anaesthesia or sedation, hospital observation, follow-up, rehabilitation if needed, complications care, accommodation and travel. Ask whether a future second-side procedure is a separate charge. These are quote questions, not claims that any item is included or excluded.
Published fee observations, not individualized quotes or confirmed availability. Stages are separate; no guaranteed total or cheapest-program ranking.
Penn Medicine
Price and currency unknown; no quote obtained. Still to clarify: total price, screening, hospital charges, follow-up, second-side treatment, international pathway.
UVA Health
Price and currency unknown; no quote obtained. Still to clarify: total price, screening, hospital charges, follow-up, second-side treatment, international pathway.
Imperial College Healthcare Private Care
Price and currency unknown; no quote obtained. Still to clarify: total price, screening, hospital charges, follow-up, second-side availability, international pathway.
Queen Square Imaging Centre
Applies to: These prices apply to patients normally resident in the United Kingdom. International patients need bespoke quotations based on their circumstances.[18]
| Stage | Fee and basis | Included as described |
|---|---|---|
| Initial neurology consultation | GBP 300 — approximate | Initial consultation; consultant-dependent fee[18] |
| MDT assessment and associated tests | GBP 1,750 — fixed | MDT consultation and all associated tests[18] |
| Treatment and one-year follow-up | GBP 25,000 — fixed | All fees associated with treatment itself and follow-up appointments for 1 year[18] |
The initial consultation is typically around GBP 300, not a guaranteed fixed fee; it varies with the consultant.[18]
Scheduled follow-up visits, including the MRI scan at 6-months, are included. Added unexpected medications or diagnostic tests arranged privately may cost extra.[19]
Not established: provider effective/expiry dates, international price, hotel inclusion, travel, tax treatment, deposits and cancellation, individual insurer approval, second-side charges. No booking or insurance coverage guarantee.
Images and explanatory material
original schematic; clinician portraits still missing
The original schematic below explains a process, not anatomy or a clinical result. Its steps have source links and a text alternative.
Clinician portraits remain an unmet obligation. Public profile identity does not grant copying permission. Penn’s photography standard requires consents for institutional use; it does not give this Hub a third-party reuse license. Next: obtain a specific licensed portrait with verified clinician identity, without sending a message in this run.
Text alternative and source-specific limits
- Specialist assessment: Confirm diagnosis, prior treatment and suitability[8]
- MRI-guided targeting: Focused energy targets tremor-related thalamic cells[3]
- Stepwise treatment and checks: Awake feedback, MRI temperature and tremor checks[3]
- Monitoring after treatment: Check benefit and problems; follow the center’s plan[9][16]
Sources, dates and disagreements
source-supported draft; review pending
NICE’s 2018 patient information concerns a unilateral procedure and says the effect on function and quality of life in people with tremor on both sides is uncertain. Its wording must not be presented as proof that staged bilateral treatment does not exist. NICE says use requires regular checks of benefit and problems because of concerns about long-term effects and complications.[9][16]
At this retrieval, NICE’s staged bilateral assessment is marked in progress, with expected publication on 17 December 2026. That is a provisional schedule, not a completed recommendation or an entitlement to NHS funding.[15]
NICE HTG474 concerns unilateral treatment-resistant essential tremor: the procedure should not be used unless there are special arrangements for clinical governance, consent, and audit or research. Clinicians should inform NHS trust governance leads, discuss one-sided limits and bilateral alternatives, provide written information, and audit outcomes.[16]
NICE requires clear written information about the unilateral limits and alternatives, and audit and review of outcomes.[16]
NICE says selection should be by a multidisciplinary team experienced in essential tremor, including clinicians specifically trained in this procedure.[16]
The US staged-bilateral description and older UK unilateral guidance have different dates and scopes. They should not be flattened into one worldwide eligibility rule. No current international regulatory or funding clearance is inferred.
The bilateral paper also contains internal inconsistencies: its abstract and Results give different age standard deviations, and its stated skull-density exclusion is not consistent with the reported minimum range. Those values are not used to create patient eligibility cutoffs here; the discrepancy is retained in the dataset for review.
Each source below carries its own retrieval timestamp. Retrieval does not mean the provider updated its page that day. Access levels distinguish excerpts, abstracts and full bodies; local evidence links expose pinned exact spans.
- Imperial Private Care: essential tremor Selected paragraphs from extracted body. Direct robots request HTTP 403, no bypass. Published date not established from body; do not infer current availability or superiority.
- Penn clinical briefing: medication-refractory essential tremor Selected procedure and faculty paragraphs. Public illustrative patient case and testimonials excluded from derived corpus. Direct HTTP was a challenge; raw challenge is not evidence.
- Penn Medicine: Casey H. Halpern, MD Professional profile excerpts only; ratings/comments, schedules and images not reused.
- Cosgrove et al.: 5-year follow-up (2022) Primary abstract, not full paper. PMC HTTP challenge excluded; Europe PMC full text request timed out.
- UVA Health: focused ultrasound for essential tremor Body extracted from delivered HTML; no image reuse. Robots permits this path; crawl delay 2 seconds.
- NICE HTG474: information for the public (2018) Historical unilateral scope; cannot be used to deny later bilateral evidence or establish current funding.
- Elias et al.: randomized trial (2016) Primary abstract. Not full Methods/Results, not a head-to-head DBS comparison.
- Kaplitt et al.: staged bilateral multicenter trial (2024) XML full text received; readable extraction includes paragraphs/tables but no image pixels or supplementary files. Internal research snapshot only: do not redistribute full article or adapt figures for commercial publication without rights review.
- UVA Health: Jeff Elias, MD Professional profile excerpts only. Research authorship alone is not operator evidence; treatment list and institution relationship used.
- NICE staged bilateral assessment: in progress Provisional schedule; expected publication 17 December 2026 is not published guidance.
- NICE HTG474: complete recommendations Complete recommendation paragraphs 1.1–1.4.
- Imperial: source-stated treatment location Selected location paragraph; booking location must be confirmed.
- Queen Square: staged assessment and treatment fees Published provider information; undated fee validity. Not an individualized quote or proof of regulatory authorization.
- Queen Square: follow-up care and additional costs Published provider information; undated fee validity. Not an individualized quote or proof of regulatory authorization.
Your next step: ask for a specialist assessment
usable information route; no referral integration
Use the official program links in the comparison to explore an assessment. No appointment, referral, quote or message has been sent by this page, and no Bookimed booking relationship is implied.
Ask: Is my diagnosis confirmed? What benefit is realistic for the hand or daily activity that matters to me? How does MRgFUS compare with DBS in my case? If I already had one side treated, do residual symptoms make a second procedure unsuitable? What is the full cost and aftercare plan? Who will assess urgent problems after I go home?
Independent review and appropriate clinical/editorial sign-off are still required before this draft can be publicly published. It is educational information, not a substitute for professional advice.
