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.”
Ld: Thank You For Allowing Our Mutual Friend To Introduce Us And For Agreeing To Answer Some Questions Most Patients Are Familiar With Deep Brain Stimulation As A Parkinsons Treatment But What Is Mrgfus
AD: MRgFUS is an incision-less therapeutic treatment, which uses MRI-guided ultrasound waves to precisely target and treat areas deep inside the brain that cause movement problems.
It sounds straightforward. However, the brain presents challenges due to the skull scattering the sound waves. By using advanced ultrasound technology in combination with real-time MRI images, we are able to refocus the energy beyond the skull and into the brain. During the treatment, we use the MRI along with an alert patient to test brain areas for accuracy by delivering a test dose, which if correct will temporarily fix the disorder. With this clinical confirmation, the full therapeutic dose is delivered, where the energy precisely creates heat to form a permanent lesion at the targeted brain area.
The treatment is irreversible and currently offered as a unilateral treatment, meaning only one side of the brain is treated. However, there is ongoing research to assess whether a bilateral approach demonstrates appropriate safety and efficacy. This would be a staged process and based on a case-by-case basis of patient symptoms.
How Quickly Will I Experience The Results Of Treatment What Are The Long
You should notice improvements while undergoing the procedure.
Essential tremor trial. In one of the pivotal safety and effectiveness trials leading to FDA approval, patients reported a 50 percent improvement in their tremors and motor functions 3 months after treatment compared to baseline and maintained a 40 percent improvement 1 year after treatment.
Tremor-dominant Parkinsons disease. In the study that led to FDA approval, patients reported a 62 percent median improvement in their hand tremor 3 months after treatment compared with baseline.
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Three Advantages Of Mrgfus For Pd Tremor
MRgFUS is a noninvasive outpatient procedure. No scalpel is needed to cut skin, no drill is needed to bore a hole in the skull, and nothing is implanted in the brain. Its three main advantages for PD-related tremor are:
A few words of caution: MRgFUS is not effective in every case. As with MRgFUS for ET, treatment will be directed to the hand in which tremor is worse, since treating both hands increases the risk of side effects. Clinical studies show that some patients have short term side effect such as headaches, dizziness or nausea but these quickly resolve. However, the effect may not be durable. Patients who have suffered with significant tremor for years may experience less effective tremor control, or gradual recurrence of tremor. Finally, MRgFUS does not cure PD, nor will it have an effect on other PD-related problems.
However, the consensus among researchers is that MRgFUS is a very promising treatment for PD-related tremor, especially as an alternative to invasive surgical procedures. If you or a loved one suffers from severe PD tremors, contact the Sperling Medical Group for more information about MRgFUS.
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How Do I Know That Mr
Our medical team will conduct a complete assessment of your condition, and will then discuss whether you are a candidate for this or other treatment options .
Generally, MR-guided focused ultrasound may be an option if you have:
- A confirmed diagnosis of tremor-dominant Parkinsons disease or essential tremor
- Tremor that is inadequately relieved by medications
- Tremor that limits your ability to perform daily activities
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Conventional Treatments For Pd Tremors
PD differs from ET in many respects, and is generally accompanied by multiple symptoms that progressively worsen. In PD, the brain cells that produce a neurotransmitter called dopamine are gradually destroyed. In turn, this diminishes muscle control, leading not only to tremors that occur at rest and during voluntary movement, but also to restricted range of motion, postural impairment, loss of balance and coordination, and cognitive deficits in many cases.
Currently, conventional tremor treatments for PD patients include a range of medications . Some patients experience eventual side effects such as dyskinesia, and over time, medications generally become less effective. Surgical procedures have helped many PD patients greatly reduce tremor, but these do not affect other PD-related impairments. Even so, patients for whom hand tremors greatly reduced their ability to function experience improved quality of life when surgical procedures are successful.
Focused Ultrasound For Essential Tremor And Parkinsons
OHSU is the only Oregon hospital to offer focused ultrasound for essential tremor and tremor-dominant Parkinsons disease. This life-changing treatment improves tremor symptoms for most patients right away. Benefits include:
Advanced technology thats safer for you. This treatment combines ultrasound with MRI. This means we can do surgery without an incision while youre awake. No cutting means no risk of problems like infection. Being awake means no anesthesia and you can see results in real time.
Improves your quality of life. Most patients have reduced tremor symptoms on one side right away. For more than 75% of patients, improvements were still there three years later.
Outpatient procedure. Most patients return to daily activities within a day. Temporary side effects of the treatment stop within a week.
To schedule an evaluation for focused ultrasound treatment for essential tremor or tremor-dominant Parkinsons disease, call our clinic at , or email us at .
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Focused Ultrasound Treatment For Essential Tremor
Essential tremor is the most common type of tremor and the most frequently encountered movement impairment. Also known as benign tremor or familial tremor, ET affects about 10 million Americans. Although it is not life-threatening, ET can negatively impact a patients daily activities.
This is particularly true of tasks involving fine movements of the hands, such as crafting, writing, painting, and personal care. Essential tremor is a progressive disorder, meaning it worsens over time. Fortunately, Sheba Medical Center now offers an effective and non-invasive treatment for ET focused ultrasound therapy .
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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Reaction To The Research
Sandeep Thakkar, DO, heads the Parkinsons and movement disorders program at the Pickup Family Neurosciences Institute in Newport Beach, California.
He says how long the ultrasound treatment is effective is debatable, but its effectiveness typically goes beyond what medications can accomplish.
We have very few medications that work and, even if they do, its short term, Thakkar told Healthline.
Jean-Philippe Langevin, MD, a neurosurgeon at Providence Saint Johns Health Center in Santa Monica, California, calls the study pretty significant.
This is mainly for patients with tremors in their upper extremities, who have trouble eating, getting dressed, things like that, medications for which dont work very well, Langevin told Healthline.
Theres a number of patients who dont want the . It could be theyre turned off by the thought of having an implant. The ultrasound treatment can be less invasive, he said.
Langevin adds that some of the risks associated with surgery are significantly reduced, although by destroying part of the thalamus, there can be risk of a person experiencing pins and needles sensations.
There can also be problems with speech. It can be garbled, he noted.
Ninety to 95 percent of people are not going to have side effects, Langevin said. Its not the entire thalamus . Its just a tiny portion.
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Thank You One Last Question: If You Had To Share One Quote About Mrgfus What Would It Be
Our ability to help people get better, live the lives they want to for longer, and in the way and fashion they want to is only getting better through science and technology. Focused ultrasound is a great example of that. Reaching out and challenging the opportunities for yourself and your loved ones is important. Ask about these therapies and make sure your neurologists, neurosurgeons, and caregivers understand what the best opportunities are for you. Think of focused ultrasound as one element of the journey to wellness certainly, one that we are very happy to bring to Parkinsons patients and their families.
Treatment plans are collaborative. It is clear that Desai is an advocate for patients understanding available treatment options as they continue to emerge. With education, we can advocate for ourselves and be part of the plan.
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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.
Focused Ultrasound Treatment In Israel
There are several treatments for ET available, some more effective than others. Medication remains the usual first choice for ET treatment. However, roughly 30% of patients show no response to pharmacologic therapy alone.
One effective treatment, used since the 1950s, is a surgery known as a thalamotomy. This operation destroys a small part of the brain called the thalamus. The surgery must be performed on both sides of the brain in order to resolve tremors on each side of the body. Unfortunately, a thalamotomy often produces many unintended effects, such as gait and speech difficulties.
Another option is deep brain stimulation . While DBS does not have as many side effects as a thalamotomy, it still involves surgery. Electrodes are placed deep into the brain in order to apply heat to the areas causing essential tremor. The drawbacks include an invasive operation and the need to regularly replace a battery.
Medical research has recently provided another possibility focused ultrasound . Focused ultrasound is FDA-approved, but is still only available at very few institutions in the US. Sheba Medical Center offers ET patients this advanced treatment with its many advantages.
First off, FUS is non-invasive. There is no electrode placement and absolutely no surgery is needed. Dr. Simon Israeli-Korn, a specialist in movement disorders and senior physician in the Neurology Department at Sheba Medical Center, puts it succinctly:
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What Are The Risks And Limitations Of Focused Ultrasound
Focused ultrasound for tremor has minimal side effects. Some patients experience temporary side effects during and after treatment. It is rare for these symptoms to last more than a week.
The most common side effects are:
- Skin irritation on the scalp
- Imbalance or trouble walking
This treatment is effective for most patients, but there are limits.
- We can only perform the treatment on one side of your body. Your non-dominant side will still have tremor symptoms. Research is underway to learn if we can use focused ultrasound for both sides in the future.
- The treatment can vastly improve your tremor, but wont stop it completely.
- This is not a cure. Essential tremor and Parkinsons disease get worse over time and this treatment cant stop the progression. You and your doctor can discuss if retreatment with focused ultrasound is best for you, or you can try another option like deep brain stimulation.
The Power Of Focused Ultrasound
It was a decade ago that Elias treated his first clinical trial volunteer with essential tremor, a common movement disorder, using the focused ultrasound technology. Since then, Elias and his neurology collaborator, Dr. Binit Shah, have been leaders in developing MRI-guided focused ultrasound as a commercially approved procedure. UVAs work, for example, paved the way for the FDA to approve the technology to treat essential tremor in 2018, and the agency has now expanded that approval to include other common Parkinsons symptoms, including rigidity and involuntary movements, for appropriate patients.
Dr. Neal F. Kassell, chairman of the Focused Ultrasound Foundation, hailed the FDAs latest approval. The foundation has long considered the brain to be a vanguard target for focused ultrasound, and this ruling by the FDA is a huge win for both providers and patients, said Kassell, a former UVA neurosurgeon.
Elias, too, is excited about what the approval could mean for Parkinsons patients. This ultrasound technology is obviously very popular with patients because it can be performed on an outpatient basis and without any incision, he said. It is still very early stage for a new procedure, so experience and technological advances will increase the safety and effectiveness.
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Mr Guided Focused Ultrasound
An Incisionless Treatment for Essential TremorMR Guided Focused Ultrasound is a treatment for essential tremor or tremor-dominant Parkinsons disease patients who have not responded to medication. Requiring no incisions, permanent implants, or radiation exposure, it uses focused sound waves guided by MRI to pass through skin, muscle, fat, and bone to treat deep in the brain.
How Does the Procedure Work?During the procedure, ultrasound waves are focused on a small point in the brainpassing safely through the skull without the need for an incision. The temperature at the target rises high enough to create a microscopic ablation or burn, providing a therapeutic effect.
Where Does the Procedure Take Place?The whole procedure is conducted inside of an MRI scanner at Mount Sinai West. Serving as the eyes of the treatment, the MRI enables your physician to plan, guide, and precisely target the area for treatment. It also acts like a thermometer, providing continuous temperature monitoring to verify that only the targeted tissue is destroyed.
Will My Tremors Go Away?Based on the current scientific literature, most patients get a 50 to 80 percent reduction in tremor maintained for up to three years.
Is This Treatment Right for Me?To determine if MR Guided Focused Ultrasound treatment is right for you, please make an appointment with the Center for Neuromodulation for a consultation.
For more information, please reach out to Tiffany Arnold, or 212-523-8130.
Who Can Benefit From Fus
FUS is suited for Parkinsons or Essential tremor patients who have undergone therapy with medication but still have a remaining tremor.While there is no upper age limit for treatment, certain conditions will preclude FUS therapy, including the inability to have a MRI and coagulation or bleeding problems.
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Is It A Relatively New Treatment In The United States
While the technology of focused ultrasound is relatively new in the United States, the company, Insightec, is 20 years old. Over the last five to seven years, Insightec has advanced technology to treat the brain and has been conducting clinical research to approve treatments for movement disorders globally. As a result of compelling multiyear clinical evidence and multiple FDA approvals, the technology has gained wide Medicare and private reimbursement coverage. It is also becoming part of training programs for neurosurgeons, where many top DBS surgeons and institutions also perform the Exablate treatment.
The FDA approval in 2016 and the successful treatment of essential tremor have driven the adoption of the technology. It has received two FDA approvals as a treatment option for Parkinsons. In 2018, it gained approval as a treatment for tremor-dominant Parkinsons for patients that do not respond to medications. In 2021, the approval expanded to include other nonresponder symptoms, including bradykinesia, rigidity, and dyskinesia. The Exablate Neuro treatment is now being offered at more than 100 centers worldwide, including the University of Maryland Medical Center, locally.