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Movement Disorders and Focused Ultrasound

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The uniquely comprehensive Movement Disorders Program prioritizes superb clinical care and leading-edge research.

At Cedars-Sinai’s comprehensive Movement Disorders Program, world-renowned experts work as a team to diagnose and treat patients at every stage of Parkinson’s disease, dystonia, essential tremor and other movement disorders. The multidisciplinary clinic provides highly coordinated visits with neurologists, therapists, social workers and clinical research coordinators, who band together to personalize patient care.

This infrastructure allows us to offer patients the chance to participate in the latest research, including a National Institutes of Health-funded trial that seeks to define the premotor phases of Parkinson’s. By pursuing subtle markers prior to diagnosis, investigators aim to map the trajectory of the disease.

"We are committed to taking care of patients at all stages of disease, including the earliest indication of Parkinson’s, before symptoms are identified. Eventually, we may be able to prevent or delay the course of the condition."
—Michele Tagliati, MD

Cedars-Sinai offers a full range of individually tailored treatment modalities, including medical management and deep brain stimulation.

In addition, the Movement Disorders Program now offers the newest surgical innovation: MRI-guided focused ultrasound, a minimally invasive procedure for essential tremor and tremor-dominant Parkinson’s. Cedars-Sinai is one of 62 treatment centers nationwide to provide this treatment option.

During the outpatient procedure, surgeons precisely target the ventral intermediate nucleus of the thalamus and ablate malfunctioning tissue with MRI-guided high-intensity sound waves. Outcomes are observable in real time; the team tests patients’ fine motor skills before and during the procedure to gauge and improve efficiency. Most patients experience an immediate 75%-80% reduction in their tremor. With experience, the team will explore new research-based indications for the technique, such as epilepsy and neuropsychiatric conditions.


Noninvasive Procedure for Immediate
Tremor Reduction

Harley Rudofsky, 81, was proud of his penmanship. At the mountain resort he and his wife owned, he handwrote letters to confirm his guests’ reservations.

About 10 years ago—long after Rudofsky had sold the property and retired to Palm Springs—he developed essential tremor in his hands, which ruined his once-elegant script. Despite the disability, he was reluctant to undergo surgery. Medications to manage the shaking had only a minimal impact.

Rudofsky learned his brother and a cousin experienced dramatic improvement in their tremors following MRI-guided focused ultrasound. After a consultation with Adam Mamelak, MD, director of the Functional Neurosurgery Program at Cedars-Sinai, Rudofsky scheduled his own procedure.

Deep brain stimulation is still considered the best surgical treatment for essential tremor, but it’s contraindicated in some patients because of their age, cardiac conditions or desire to avoid open-brain surgery. For such patients, focused ultrasound is a safe, reliable and immediately effective alternative.

Before the procedure, Mamelak and his team merged Rudofsky’s MRI and a brain atlas to target the treatment more specifically. They aimed hundreds of pinpoint ultrasound beams at the ventral intermediate nucleus of the thalamus to incrementally heat the tissue responsible for the tremor in his right hand while repeatedly testing his response and measuring for side effects. Following the two-hour procedure, Rudofsky remained in recovery for only an hour before he was discharged.

The improvement in his tremor was immediate, and Rudofksy can now easily use his right hand to write. He remains grateful not only for the outcomes, but for the experience. “The people who surrounded me were so gentle and caring,” he said. “The warmth Dr. Mamelak displayed and the respect he had for all the people in the room made me so comfortable.”

Rudofksy hopes to have a second procedure to treat his left hand soon. In the meantime, the reduction of the tremor allows him to stay active. He and his wife volunteer at food distributions and the Palm Springs Art Museum and enjoy walking their dog, riding bikes and swimming.


Adam Mamelak, MD
Director, Functional Neurosurgery Program
Co-Director, Pituitary Center
Professor of Neurosurgery

Michele Tagliati, MD
Caron and Steven D. Broidy Chair in Movement Disorders
Director, Movement Disorders Program
Vice Chair, Department of Neurology
Professor of Neurology