Advantages Of Mrgfus For Parkinsons Disease Tremors
In 2016, Forbes Magazine carried an article on MR-guided Focused Ultrasound for essential tremor . Citing positive results from clinical trials, the article explained that The treatment doesnt require any implants, incisions or ionizing radiationi. As the news spread, Parkinsons disease patients who also suffer from tremors wondered if MRgFUS could eliminate their tremors, too.
What About Side Effects
Like any type of surgical procedure, potential side effects and complications occur from time to time.
Side-effects reported include numbness in the face or hand, and gait disturbance.
In most cases these are mild and temporary, but they can be ongoing in some patients.
The long-term safety profile indicates that 74% of adverse events were mild, and the rest were moderate.
Of the total adverse events, almost 50% resolved within 30 days of the procedure.
Specifically, the most common side effects are:
- musculoskeletal weakness 2%
About Dr Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Neurosurgery Associates.
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For Tremor Dominant Parkinsons Disease
Parkinsons disease is the second most common neurodegenerative condition, affecting about 1% of people over 60 years old. MR-guided focused ultrasound has become an attractive treatment option to improve tremor control for patients who do not respond to dopamine replacement medications.It is essential to recognize that focused ultrasound is not a cure for Parkinsons disease, and it does not stop the progression of the disease. Some motor symptoms such as balance difficulties, speech problems, swallowing difficulties, and cognitive decline develop or worsen as Parkinsons disease progresses and usually do not improve with focused ultrasound. Similarly, the non-motor complications of Parkinsons disease, such as depression, problems with thinking or memory, constipation, or urinary changes do not improve after focused ultrasound.
Focused Ultrasound Shows Promise For Parkinsons Disease
Jeff Elias, MD, pioneered the use of focused ultrasound for the treatment of essential tremor and Parkinsons disease.
A scalpel-free alternative to brain surgery has the potential to benefit people with Parkinsons disease symptoms that are much more severe on one side of the body, new research suggests.
More testing is needed, but the approach, which uses a technology called focused ultrasound, could offer a new option for patients whose symptoms are poorly controlled by medications and those who cannot or do not wish to undergo traditional brain surgery.
This small brain region, the subthalamic nucleus, had a very strong and potent effect on Parkinsonian symptoms when we targeted it with precise, focused ultrasound energy, said researcher Jeff Elias, MD, a neurosurgeon at UVA Health and a pioneer in the field of focused ultrasound. The key for the ultimate adoption of this new procedure will be further refinements of the technology to ensure reliability and safety.
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Join The Parkinsons Forums: An Online Community For People With Parkinsons Disease And Their Caregivers
With the new technology, clinicians direct ultrasound waves to a brain structure called the globus pallidus, which helps regulate voluntary movement, to destroy damaged tissue, decreasing the uncontrolled movements that characterize Parkinsons disease.
Doctors use magnetic resonance imaging to create a temperature map of the brain, giving them a real-time picture of the region they want to hit with the sound waves. They then raise the energy, directly targeting that area of the brain to destroy the tissue.
Patients are awake and alert the entire time in the MRI scanner, enabling them to give clinicians constant feedback. They are fitted with a helmet through which the energy is converted into sound waves, which are then targeted to the globus pallidus. The approach is noninvasive, meaning there is no surgery or radiation treatment involved.
Current therapies to lessen movement and coordination problems in Parkinsons patients include levodopa , which is the most common. Patients with advanced Parkinsons may undergo surgery, known as deep brain stimulation, to implant micro-electrodes in the brain that help control tremors, rigidity and dyskinesia .
For people with Parkinsons disease and other movement disorders such as essential tremor, focused ultrasound is an appealing alternative to deep brain stimulation because it does not involve more invasive surgery, said Paul S. Fishman, MD, PhD, professor of neurology at UMSOM and a neurologist at UMMC.
Clinical Outcomes And Adverse Events
Gamma knife thalamotomy has been shown to improve motor function in patients with PD. The radiation dose used in GK thalamotomy ranges from 120 to 180Gy, and it appears that doses less than 120Gy do not provide clinical benefits . In a prospective study of unilateral gamma knife thalamotomy for patients with PD and essential tremor , Ohye et al. reported an improvement in tremor scores , with 81.1% of patients evaluated as having good or excellent results at 24-month follow-up . A more recent prospective, single-blind study of unilateral GK thalamotomy for patients PD and ET reported a 54.2% improvement in the upper limb tremor score . GK pallidotomy has also been performed to treat PD, although only a few reports have described the procedure . The GPi is considered a high-risk target for GK radiosurgery due to its proximity to the optic tract and the risk of optic neuropathy . Likewise, the STN is not an advised target due to the risk of neurologic complications including hemiparesis, dysarthria, and gait disturbances .
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Mrgfus As An Alternative To Surgery
MR-guided Focused Ultrasound is a new technology that uses sonic energy to ablate the tiny area of the brains thalamus that produces tremors. Advances in MRI allow accurate mapping of the thalamus to facilitate treatment planning, and also to guide the treatment itself. Improvements in ultrasound technology allow the sonic energy to be focused at the target from many directions when they converge upon the target, it produces the intense heat that accomplishes the ablation.
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Mrgfus Focused Brain Ultrasound
Watch this remarkable video of another one of our MRGFUS patients who has benefited from their treatment under the watchful eye of our team. His tremor is treated and you can see the control he now has over his shaking immediately post procedure.
MRI-guided Focused Ultrasound is noninvasive treatment, used primarily to treat essential tremor, tremor-dominant Parkinsons disease, and certain types of chronic pain.
After a single treatment, most patients report an immediate relief or significant improvement in their symptoms.
Focused ultrasound can penetrate the skull without the need to make an incision or drill holes in the skull.
Precision can offer short wait times for MRgFUS. We can see you within four weeks for a consultation and, if suitable, administer your treatment within three months of you contacting us.
If you have additional questions, please email .
Focused ultrasound is an innovative neurosurgical platform which delivers ultrasound energy deep in the brain with incredible precision.
This deliberately creates a small scar or lesion in the brain without incisions.
This procedure is carried out without anaesthetic or incisions.
The neurosurgeon and neuroradiologist sit at a computer console in the MRI control room, using a computer and mouse instead of a surgical scalpel.
But, at the focal point, the multiple beams of focused ultrasound energy converge, and this results in many important biological effects.
Have a question? Email your referral or enquiry to .
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A New Era For Parkinson’s Disease Treatment
“A diagnosis of Parkinson’s disease no longer automatically portends a future of extremely limited physical capabilities. Thanks to the commitment of researchers like Dr. Eisenberg and Dr. Fishmanand clinical trial participants like Steve Squirestreatment has expanded to include non-invasive options that significantly reduce certain symptoms within minutes and transform the lives of people who had been living with debilitating symptoms,” said Bert W. O’Malley, MD, President and CEO of the University of Maryland Medical Center.
“Our school of medicine researchers have established themselves as world leaders in pioneering MRI-guided focused ultrasound for many devastating brain diseases, including Parkinson’s and essential tremors,” said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. “The stellar work of Dr. Eisenberg and Dr. Fishman has led to a new era in which this breakthrough modality has now become the standard of care for patients looking for less invasive treatments for their symptoms.”
About Uvas Focused Ultrasound Research
UVA has been at the leading edge of research into focused ultrasounds potential to treat disease. For example, the federal Food and Drug Administration approved the technology for the treatment of essential tremor, a common movement disorder, based on Elias pioneering research. His work also paved the way for the FDA to authorize the technology to treat tremors caused by Parkinsons disease.
Other researchers at UVA are investigating the technologys potential to treat a wide variety of conditions, including epilepsy and breast cancer.
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What To Expect From Focused Ultrasound Treatment
Before your focused ultrasound treatment:
- Meet with Dr. Ahmed Raslan, neurosurgeon, to discuss the benefits and risks of focused ultrasound. We will also evaluate your condition to make sure focused ultrasound is the right treatment for you.
- You will need an MRI before treatment. If you already had an MRI with your neurologist, you may not need another one with us.
On treatment day:
- When you arrive for treatment, we will completely shave your head. This makes sure that nothing will block the ultrasound waves.
- You lay on a table that can slide in and out of an MRI machine during the procedure.
- We use numbing medicine at four different points on your scalp, then use pins to attach a frame. This frame will make sure your head is completely still during the procedure.
- We fit your head into a water-filled helmet that has more than 1000 ultrasound transmitters.
- We will find a baseline by asking you to draw a spiral or touch your nose.
- We can view your brain and control the ultrasound waves from a computer.
- We start with a test lesion. This is a temporary change to confirm that we are in the right place in your brain.
- This outpatient procedure takes up to three hours. You will be able to go home that day or the next day.
- You may experience brain swelling in the area for up to a week. This could cause temporary numbness, imbalance, or other neurological issues.
- Improvement to your tremor symptoms is immediate during the procedure.
Are Some Patients Not Candidates For Mr
This procedure may not be suitable for patients:
- With non-MRI compatible implants, including some pacemakers, neurostimulators, spine or orthopaedic implants
- With extensive scarring on the scalp
- With tumours in the brain
- Who are on dialysis
- Who have an active infection
- Who cannot lay still on a table for up to 4 hours
- Who are unable to stop antiplatelet or anticoagulation therapy
- Have significant claustrophobia
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What Are The Side Effects Of Mr
The most common side effects include:
- Temporary numbness and tingling in the lips or fingertips
- Temporary unsteadiness and balance problems
- Temporary speech or swallowing problems
These side effects sometimes start several days or weeks after treatment.
If you have additional questions, please email .
Research Into Focused Ultrasound
Ongoing research on focused ultrasound for Parkinsons is evaluating the procedure in different brain areas affected by Parkinsons, such as the subthalamic nucleus and the pallidothalamic tract. At the same time, scientists are looking at the possible benefits and safety of both-sided FUS in different targets as well as the best practices for performing this procedure.
Researchers also are studying how ultrasound could help other Parkinsons treatments, such as antibodies against alpha-synuclein or gene therapies, get into the brain more easily and efficiently by temporarily opening the brains protective barrier.
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Connecting To Treatment For Movement Disorders
Typically, patients will see a movement disorder specialist prior to consideration for focused ultrasound therapy. The University of Maryland Parkinson’s Disease and Movement Disorders Center provides evaluation, care, and treatment for patients with a wide variety of movement disorders such as essential tremor, Parkinson’s disease, and dystonia. It is staffed by 6 board-certified neurologists. To make an appointment with one of our Movement Disorder Specialists, call 410-328-4323. Learn more.
To schedule a consultation with one of our neurosurgeons, call 410-328-6034. Learn more about our Neurosurgery services.
About the University of Maryland Medical Center
About the University of Maryland School of Medicine
Focused Ultrasound Treatment For Essential Tremor
For patients with essential tremor , the uncontrollable shaking of the hand, head, and voice can interfere with nearly all aspects of life. A new outpatient procedure that uses high-intensity ultrasound has been shown to significantly reduce tremor symptoms for years in most patients. Shervin Rahimpour, MD, assistant professor of neurosurgery, explains how the procedure works and how effective it can be to help essential tremor patients.
Interviewer: Focused ultrasound to treat essential tremor and how to decide if it’s a good option for you. Dr. Shervin Rahimpour is a neurosurgeon who specializes in the treatment of essential tremor. Who is a good candidate to get relief if they have tremor symptoms using this treatment? Let’s just start there.
Dr. Rahimpour: Essential tremor is the most common movement disorder and affects upwards of 10 million people in the United States. It’s characterized by this either postural tremor when you try to maintain a posture with your hands or it can be brought about when you’re trying to perform some kind of physical action with your hands. And it doesn’t necessarily just affect the hands. It can affect people’s voice, their balance, and other extremities.
While there are effective medications for essential tremor, some patients don’t either respond to these medications or have bad drug side effects, and we have good interventions to try to treat this surgically.
Interviewer: And how does focused ultrasound work then?
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Expanded Indication Includes Medication
byJudy George, Senior Staff Writer, MedPage Today November 5, 2021
The FDA expanded the approval of Exablate Neuro focused ultrasound to treat advanced Parkinson’s disease patients with mobility, rigidity, or dyskinesia symptoms, device maker Insightec announced Wednesday.
With this new indication, Exablate Neuro is approved for unilateral pallidotomy in medication-refractory Parkinson’s patients with moderate to severe motor complications.
The device uses MRI-guided focused ultrasound waves to target and ablate the globus pallidus, requiring no incisions or brain implants. “Movement disorder neurologists now can offer their Parkinson’s patients a less invasive surgical option as part of their treatment plan,” said Paul Fishman, MD, PhD, of the University of Maryland, in a statement.
Exablate Neuro previously was approved to treat medication-refractory essential tremor and tremor-dominant Parkinson’s disease.
Early studies suggested that focused ultrasound subthalamotomy and pallidotomy performed on one side may reduce motor manifestations of Parkinson’s disease. A sham-controlled trial of patients with markedly asymmetric Parkinson’s disease found that focused ultrasound subthalamotomy performed in one hemisphere resulted in improved motor scores at 4 months, but was associated with adverse events including dyskinesias and other neurologic complications.
Who Can Have Mri
MRI-guided focused ultrasound may be a treatment option for people with essential tremor or with Parkinsons disease when hand tremor is the primary symptom and medications have not worked. Patients with essential tremor must be at least 22 years old and patients with tremor-dominant Parkinsons disease must be at least 30 years old to receive this treatment.
MRI-guided focused ultrasound is not suitable for all patients. You may not be eligible if you have:
- Metallic implants such as a pacemaker, neurostimulator, spine or bone fixation device, total joint replacement, metal clips, screws or cochlear implants
- Heart or spine issues that may make it difficult to tolerate the treatment or lie still for about 3 hours
- Extensive scarring on your scalp
- Tumors inside your skull
What is the Neuravive treatment? Neuravive is a new treatment for essential tremor where sound waves are focused through the skull to a target without the need for incisions, brain implants or radiation. It is based on high intensity focused ultrasound guided by MR imaging. During the procedure ultrasound waves pass through the skull and are focused on a specific target in the brain. The temperature at the target rises high enough to create a tiny ablation or burn and provide a therapeutic effect, reducing the hand tremor. The MRI scanner provides images for the physician to clearly see the treatment area and provides images that show changes in temperature at the target.
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Fda Approval Of Focused Ultrasound Device Provides Patients With Novel Treatment Option Without Requiring Incision
A non-invasive ultrasound treatment for Parkinsonâs disease that was tested in a pivotal trial led by University of Maryland School of Medicine researchers is now broadly available at the University of Maryland Medical Center . The device, called Exablate Neuro, was approved in November by the US Food and Drug Administration to treat advanced Parkinsonâs disease on one side of the brain.
The approval was based on findings from the UMSOM clinical trial and effectively expands access to focused ultrasound beyond clinical trial participation.