high-intensity focused – Robert Goings’ Parkinson’s symptoms were intense enough that his doctors needed them “full blast” for surgery—so he couldn’t sleep the night before. The next morning at OHSU in Portland, clinicians fired 1,024 ultrasound beams at targeted spots deep in his bra
The night before his brain surgery, Robert Goings couldn’t sleep.
“My legs would cramp up. my arms. you know. everything would cramp up without the medication. ” he told his wife’s memory through the words she carries. “He was pacing all night,” says Diana. Doctors wanted his symptoms unmasked for the procedure. which meant he had to feel what Parkinson’s was doing—full blast. without the usual help.
On the morning of last November 5, Goings, 68, slid into an MRI machine at Oregon Health and Science University, or OHSU, in Portland. While he lay inside the MRI tube, doctors aimed 1,024 ultrasound beams at several spots deep in his brain—burning the problematic tissue there.
Afterward, he was wheeled to a recovery room. Diana recalls a small, stunned moment: “He held out his hand — dead still.” Then she remembers thinking, “Oh my God, I don’t believe this. It’s gone. Absolutely gone.”
Goings had chosen a treatment called high-intensity focused ultrasound. In his case, it wasn’t a temporary fix. It’s designed to leave permanent lesions in the brain. and he became part of a small but growing group willing to try it. At OHSU, an estimated 50 to 60 people have undergone the surgery, and the treatment calendar is booked up months in advance.
The technology he received reflects a shift in how widely it can target Parkinson’s. The U.S. Food and Drug Administration approved the earliest version of the treatment for certain Parkinson’s patients in 2018. after clinical trials showed positive results. The latest version. approved in 2025. extends the treatment to include a new target in the brain that appears to ease more than tremors—also including movement symptoms such as slowness and stiffness. It can also be done to both sides of the brain, rather than limiting treatment to one side.
Neurosurgeon Daniel Cleary, who has helped lead the focused ultrasound efforts at OHSU and performed Goings’ procedure, said people often go in without believing what they’ll see. “But the before-and-after experience can be profound.”
For Goings and others, the procedure has reached beyond the visible shake. Parkinson’s can interrupt everything—from where people feel safe, to how they move through a day, to whether they feel able to step outside at all.
Robert Goings described the isolation that comes with tremor: “You get so that you don’t really like to be out in public when you shake a lot.” He said other people notice—“It’s a dead giveaway”—and isolation can ripple outward into poorer health overall, neurologist Delaram Safarpour said.
Even in the months when relief is still settling, the improvements people report can be stark. Data generated in a yet-to-be published clinical trial of 40 people show that when the treatment is delivered to both sides of the brain. it can improve movement disability symptoms by an average of about a third compared with symptoms when patients are not taking medication. Three months out, 86 percent of study participants said their Parkinson’s symptoms had improved overall.
Cleary said many of his patients have had tremors for years, sometimes decades. “When they come out of the procedure and look at their hand. they are amazed that it’s not shaking anymore. ” he said. He described the emotional chain reaction: “Families get very emotional. The patients get emotional. We get emotional. It’s a big thing.”.
High-intensity focused ultrasound is not yet widely available. In the United States, Cleary said it is mainly large academic centers that have the expertise to perform it. Questions still linger. too—because the technique is relatively new. and because the method. like other Parkinson’s treatments. is symptom-focused. It can relieve problems, but it doesn’t stop, or even slow, the brain destruction caused by the neurodegenerative disease.
Still, supporters emphasize what the procedure can change in the day-to-day life of people living with severe symptoms. One reason it draws attention is what it doesn’t do: the procedure involves no cutting into the head, no anesthesia, and no recovery in a hospital.
On the way north to OHSU from their home in Lebanon. Ore. Goings and Diana drove through a violent rainstorm with poor visibility and lots of curves. Robert was driving—even though they’d expected Diana to drive home—because by the day after his procedure he was feeling so good he could take the wheel.
To understand what focused ultrasound is aiming at. it helps to trace what Parkinson’s harms and what treatments try to offset. The disease is marked by the death of a cluster of nerve cells deep in the brain called the substantia nigra. Those cells make dopamine, a neurotransmitter crucial for movement. One common treatment is levodopa, which adds back some of the missing dopamine. Carbidopa boosts levodopa’s effects, and other medications influence dopamine signaling.
But as Parkinson’s progresses. these medicines become less effective. and increasing doses can trigger debilitating side effects such as uncontrolled movements. In later stages, deep brain stimulation, or DBS, is an option for some people. It works like a pacemaker for the brain, stimulating nerve cells to reduce symptoms. Yet some people aren’t eligible—either because they are not healthy enough or because they don’t want permanent implants that require ongoing medical management.
Focused ultrasound is built for a different trade-off. Clinicians use a helmet that can dispense 1,024 ultrasound beams. The waves. like the ones used for babies’ sonograms. enter the head. pass through the skull. and intersect at a precise spot deep in the brain. During the procedure. which lasts a little under an hour. the heat generated at the intersection is used to create a lesion.
Pablo Villoslada. a clinical neurologist at Hospital del Mar in Barcelona who is exploring less intense ultrasound waves to treat dementia. multiple sclerosis and amyotrophic lateral sclerosis. or ALS. described ultrasound in terms of basic physics: “Ultrasounds are just mechanical waves — the same thing as if you drop a stone in a pond.” Because the waves can. in principle. reach anywhere in the brain. he said ultrasound methods could apply to a wide range of neurological and mental health ailments. such as eating disorders. mood disorders and chronic pain. “You need to select the right target, the right patient, the right circuit, the right stimulation,” he said. “A lot of research must be done, but the potential is very high.”.
For Goings, the day required more than the procedure itself. As a Navy diver earlier in life, he had gone deep underwater in Pearl Harbor, practicing in darkness while wearing a blacked-out Mark V diving helmet. “You have to be able to feel,” he said. “Steady hands. No panicking.”
At OHSU, the experience was different, but still controlled and precise. His head was shaved and mounted in a tight-fitting brace. Screws poked into his skin to keep everything steady. The procedure was done inside an MRI so Cleary and colleagues could find the right spots to hit. Before Goings went into the machine, staff pumped water into a flexible bladder sitting on top of his head. The liquid helped conduct the sound waves into the head and helped keep his head from heating under the beams. Throughout the treatment, clinicians slid Goings in and out of the MRI tube several times to test his symptoms.
Safarpour. who is a neurologist and movement disorder specialist at OHSU. described Parkinson’s as a problem of networks rather than one isolated spot. Movement results from a complex web of neural areas. with some areas acting like the gas pedal and others throwing on the brakes. “It’s a big circuit that has to work in a balance,” she said.
In Parkinson’s. taking out one of the “brakes” with ultrasound is meant to restore that balance—removing part of a circuit to bring equilibrium back. “People will start having more movements than they should,” Safarpour said. “Taking out one of the brakes with ultrasound ‘is cutting a part of the circuit in order to bring the balance back.’”.
In focused ultrasound for Parkinson’s, two such braking regions are used as targets. The first is the ventral intermediate nucleus of the thalamus. or VIM. a target associated with tremors when patients try to move. It is also a key symptom of a condition called essential tremor. Tremor signaling involves pathways that run from the cerebellum at the back base of the brain up to the motor cortex. Cleary said. “We don’t fully understand how the brain circuits work that affect tremor. ” but “we know that if we can knock out part of that pathway. the tremors get better.”.
The second target is the pallidothalamic tract, or PTT, which is central to the latest FDA approval. A lesion there can ease slowness, stiffness, and dyskinesia—irregular involuntary movements. Cleary added that the PTT target can also ease pain caused by constant rigid muscles that is almost universal among Parkinson’s patients. “Because they’re so rigid, so locked in, they get really severe pain,” he said.
Cleary aimed for the left side of Goings’ brain because Goings’ tremors were worse on his right side. Cleary generally targets both VIM and PTT. The procedure is done in stages: clinicians first use ultrasound intensity high enough to temporarily disable the tissue without permanently burning it. That allows doctors to test whether the patient experiences relief before creating the permanent lesion.
Goings remembers feeling the turning point. “There was one point about three quarters of the way through, I came out of there smiling,” he said. He grinned because he felt his symptoms improve. “I said, you got the right spot,” he said.
Diana recalls the doctor’s reply: “Oh no, we can do better than that.” They did.
Since the procedure, Goings said his symptoms on the right side of his body have eased dramatically. “There are no ands, ifs or buts about it,” he added. “I am one hundred percent no regrets.”
Like many patients, Goings stayed on his medications, and the ultrasound treatment offered added benefit. He is waiting to have the other side done, which requires at least a six-month wait while doctors see how he responds to the first procedure.
Other patients described similarly dramatic moments. Gary Gilson. a 68-year-old former surgical assistant in Hillsboro. Ore. said he was shaking so hard that technicians used weights and straps to keep him still during his procedure. He expected it—he hadn’t eaten much and hadn’t had any medication. But “All of a sudden. it just stopped … I was fighting it and then the next thing you know. it was gone.”.
Both Gilson and Goings said Parkinson’s influenced their retirement. Gilson retired earlier than planned. while Goings. a draftsman who later worked as a civil engineering technician. said his lettering changed and he was often tired and ill from his medication. “The symptoms kept getting worse, and I actually retired at 62,” he said. “A portion of the decision in retiring was the Parkinson’s.”.
In the three months since, Gilson said his tremors improved. He said the biggest difference is pain from muscle rigidity on his right side has largely disappeared. Because his left side wasn’t as symptomatic. he and his doctors are waiting to decide whether he will go back for treatment on the other side.
Linda Grant, from the small mountain town of Sisters in central Oregon, said tremors wore her out. “My body fights every single tremor I have. My brain wants to stop it. So I think that’s what tires me out so much. It’s exhausting, actually.”
During her procedure, clinicians tested her symptoms by asking her to use a stylus pen to trace a spiral and draw lines on a tablet. Each time she came out of the MRI tube, her lines became more precise and steadier. Her tremors eased, and her right arm grew less rigid.
Afterward, as she settled into the recovery room, a nurse handed her a cup with no straw. Before her procedure, she wouldn’t have been able to drink from it easily. Since treatment. Grant said her tremors in her right hand have improved. though she still experiences tremors there when her left side shakes.
Cleary said a common side effect of the procedure is temporary balance problems, lasting a few weeks to months. He said those typically clear up and leave a person sturdier. Grant said she has had trouble walking and has been working hard in physical therapy to stay strong and mobile. She said she doesn’t hesitate about whether she’ll treat the other side: “I can’t wait.”.
At OHSU, nurse manager Christine Larsen—coordinator of the focused ultrasound program—checks in with patients after their procedure. She usually asks how their night went. She remembers one man answering that he had slept without waking for the first time in 20 years. His wife said. “I woke up and I thought he was dead. because I’m used to sleeping with somebody who’s in constant movement. constant tremor.”.
Relief can last for a while, though the time horizon for Parkinson’s is still uncertain. Data from patients treated for essential tremor. reported in 2022 in the Journal of Neurosurgery. show that improvements can last for at least five years—matching the length of follow-up so far. “How long relief might last for Parkinson’s patients is not at all clear,” the story notes.
Parkinson’s does not stop. Along with the death of nerve cells in the substantia nigra, other changes unfold over time. A sticky protein called alpha-synuclein clumps up and spreads elsewhere in the brain, interfering with brain activity. Systems that handle smell and digestion become disordered.
Against that relentless backdrop, people are searching for relief for as long as they can get it. Even if focused ultrasound doesn’t cure Parkinson’s, Cleary said it can help people get through their days. “It’s a tough disease,” he said. “This makes a huge difference in their life.”
These early days come with unanswered questions. Efforts are underway to learn which patients might benefit most. when to treat them. and how to choose targets in the brain for each person. Plans are in the works to further study the PTT as a Parkinson’s target. Researchers are also searching for ways to stop or slow the disease itself.
Clinicians at OHSU perform the procedures every Wednesday and every other Monday, usually treating about five people a day. But access remains a major hurdle. Many people don’t know focused ultrasound is an option. there aren’t enough surgeons and clinicians trained to do it. and the cost is not always covered by health insurance.
Safarpour said making a compelling case to insurance companies requires more data. In large centers like OHSU. she said they gather important data from patients and turn the findings into scientific papers showing improvements in quality of life and symptoms. “When it comes to insurers, ‘that’s the way to fight back,’” she said.
Cleary sees the future for people with Parkinson’s as brighter than it was a decade ago. He recalled that the first patient he treated with the new approach went from being unable to walk well to fluidly walking down the hall. “Seeing the profound effect on this single patient has really inspired a lot of people to say. ‘OK. maybe we should go forward with this. Maybe this is something that’s really powerful,’ ” he said.
For Gilson, the next step is already lined up. “I’m going on vacation with my wife,” he said. They plan on visiting England, Germany and the Netherlands, and the Gilsons have also bought a camper for future trips.
Goings is keeping busy closer to home—chopping firewood and rambling walks with his dog Scooter. Diana says when faced with a challenge, Robert’s instinct is the same as ever: “Give me some more.”
“There’s no cure for it right now,” Goings said. “But this is as close as I think you’re going to get.”
Parkinson’s disease high-intensity focused ultrasound HIFU FDA approval 2025 OHSU deep brain stimulation levodopa dopamine VIM pallidothalamic tract dyskinesia substantia nigra neurodegenerative disease