Riverside Health System Now Offering Cutting
Riverside Health System is excited to announce that MRI Guided Focused Ultrasound is being used by Riverside neurosurgeons at Riverside Regional Medical Center for the treatment of medication-refractory essential tremors and tremor-dominant Parkinsons disease.
The procedure uses sound waves to precisely ablate deep brain targets that cause tremors with no surgical incisions. The treatment is performed in a single session under Magnetic Resonance Imaging guidance for high resolution visualization of the patients anatomy for precise targeting, real-time temperature monitoring and immediate confirmation of treatment outcomes. The result for many patients is immediate improvement of tremors with minimal complications.
We are excited to be among the first medical centers in the area to offer this innovative procedure and transform the lives of those living with tremors, said Dr. Jackson Salvant, a Neurosurgeon with Riverside Hampton Roads Neurosurgical and Spine Specialists. This technology provides our patients with an opportunity to drastically reduce their tremor with little to no side effects.
This new technology works with an existing, compatible MRI unit at Riverside Regional Medical Center . Riverside neurosurgeons performed the first Focused Ultrasound treatment at RRMC on Monday, September 19, 2022.
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Ultrasound Treatment Shows Promise For Managing Tremor
Positive results from a clinical trial of focused ultrasound therapy for tremor have been published in The New England Journal of Medicine.
Studies using focused ultrasound for Parkinsons are currently underway and if successful they could provide a non-invasive alternative treatment for people with Parkinsons.
Dr Beckie Port, Senior Research Communications Officer
Researchers at INSIGHTEC, a company with a focus on non-invasive surgical treatments, carried out a trial of their focused ultrasound treatment on 66 people with essential tremor and found significant improvements in hand tremor after 3 months.
Essential tremor is a type of uncontrollable shake or tremble in part of the body.
It is a separate condition to Parkinsons but this form of treatment may prove to be helpful for people with Parkinsons in the future.
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Accessing The Risks And Breakthroughs
It’s taken Insightec, a company of now 300 employees, about 15 years and $200 million to fully develop its technology: focused ultrasound therapy coupled with MRI that targets tissues deep within the brain and either thermally ablates it destroys the tissue by cooking it, basically or disrupts cell membranes similar to how ultrasound is used to break up kidney stones.
Focused ultrasound is analogous to using a magnifying glass and focused beams of light on a point. Patients are awake during the entire procedure, which usually takes between two and four hours. They’re first fitted with a helmet through which the ultrasound waves are sent and are then placed inside an MRI scanner. Multiple beams of ultrasound energy are focused on a target deep within the body. Coupling it with MRI means a doctor can monitor where the beams are hitting in real time, raising the energy levels of the ultrasound waves along the way.
We see this as a multibillion-dollar market that’s just emerging. Where robotics surgery was 10 to 20 years ago is where we think focused ultrasound is today.Maurice FerréInsightec CEO
“The beams concentrate and can affect tissue now in 18 different ways that we know of. Ten years ago we only understood three ways,” said Dr. Neal Kassell, chairman of the Virginia-based Focused Ultrasound Foundation.
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New Ultrasound Technology For Treating Parkinsons Disease Patients Under Clinical Trial
Researchers from the University of Maryland Medicine and from its Center for Metabolic Imaging and Image-Guided Therapeutics are conducting the first clinical trial with ultrasound waves to treat Parkinsons disease patients. Using magnetic resonance imaging , they guide ultrasound waves through the intact skin and skull to a deep brain region, the globus pallidus. This structure regulates voluntary movement and can be targeted by medication and surgery to treat motor symptoms of tremor, rigidity and dyskinesia in patients with PD.
Levodopa is the current treatment for PD and can temporarily diminish motor symptomatology. However, in the long term, levodopa side-effects include involuntary movements called dyskinesias. Patients with advanced PD whose symptoms are not treatable by medication may undergo a surgical procedure known as deep brain stimulation. One of the brain regions stimulated by implanted electrodes is the globus pallidus though this surgery has associated risks.
This new procedure lasts two to four hours with patients awake and lying on an MRI scanner with a head-immobilizing frame fitted with a transducer helmet. Ultrasonic energy is targeted through the skull to the globus pallidus of the brain, and images acquired in real-time. This allows the physicians to monitor the area being targeted and to make adjustments if necessary.
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 Parkinsons 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 Parkinsons 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 Parkinsons 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 Parkinsons disease.
Early studies suggested that focused ultrasound subthalamotomy and pallidotomy performed on one side may reduce motor manifestations of Parkinsons disease. A sham-controlled trial of patients with markedly asymmetric Parkinsons 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.
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Ventral Intermediate Nucleus Thalamotomy
Adverse events that transiently occurred during sonication in PD patients included the following: short lasting vertigo , headache , dizziness , nausea , burning scalp sensation , and lip paresthesia . Adverse events that lasted after the procedure included the following: asthenia , gait ataxia , unsteady feeling , unilateral taste disturbances , and hand ataxia . No adverse event lasted beyond 3 months. For a complete list of adverse events reported in this paper which also included essential tremor patients, see .
Lesions in the planned target were close to spherical with a diameter of 49mm . We observed mild edema one day after the procedure with increased edema one week after the procedure. The edema lasted for 35 weeks following the procedure. At 3 months, the edema resolved and lesion decreased in size.
The mean maximal temperature at the target was 56.5 ± 2.2°C . Patients underwent on average 21.1 ± 8.3 sonication with an average maximal sonication time of 16.2 ± 3.0 seconds . The mean maximal energy reached was 12,750 ± 4385 Joules .
Recently, Bond et al. reported in abstract form preliminary results of their double-blinded, randomized controlled trial to investigate the effectiveness of MRgFUS thalamotomy in tremor-dominant PD. They found that MRgFUS showed a trend toward improvement in hand tremor and a clinically significant reduction in mean UPDRS. They also noted a significant placebo response. Further information regarding this study is not yet available.
The Motor Network In Parkinsons Disease And Dystonia: Mechanisms Of Therapy
open to eligible people ages 21-75
This is an exploratory pilot study to identify neural correlates of specific motor signs in Parkinsons disease and dystonia, using a novel totally implanted neural interface that senses brain activity as well as delivering therapeutic stimulation. Parkinsons disease and isolated dystonia patients will be implanted unilaterally or bilaterally with a totally internalized bidirectional neural interface, Medtronic Summit RC+S. This study includes three populations: ten PD patients undergoing deep brain stimulation in the subthalamic nucleus , ten PD patients with a globus pallidus target and five dystonia patients. All groups will test a variety of strategies for feedback-controlled deep brain stimulation, and all patients will undergo a blinded, small pilot clinical trial of closed-loop stimulation for thirty days.
San Francisco, California
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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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How Do I Request An Initial Consultation
If you are suffering from Essential Tremor, Parkinsons disease or another type of tremor or movement disorder and would like to know whether you might be suitable for treatment with focused ultrasound, please request a consultation and our clinical care coordinator will contact you:
Alternatively, please email your referral or enquiry to
Our assessment process includes:
- Confirmation of your diagnosis and its impact on your quality of life.
- Other relevant medical condition and medications you are on.
- Brain scanning with MRI and CT
Our clinical assessment team includes a movement disorder neurologist and neurosurgeon.
Our clinical care coordinator will coordinate all aspects of your assessment from the time we receive your referral. If you have any questions, please contact us.
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Patient: Focused Ultrasound Changed My Life
Parkinson’s disease not only progressively robs people of their mobility it often erodes their social networks built over years of shared interests and experiences. Symptoms such as involuntary headshaking and jerking of the limbs can make many people who have the disease feel acutely self-conscious, to the point they withdraw from most social activity.
One man who managed to stave off this devastating outcome was an early participant in clinical trials for focused ultrasound led by UMSOM researchers at UMMC. For this patient, relief came within minutes after the procedure began–which ultimately eliminated 95% of the involuntary movements caused by his medication and reduced his tremors by half. Over seven years later, these outcomes have lasted, although his disease has advanced on other fronts.
“The focused ultrasound I received at the University of Maryland Medical Center changed my life by giving me back the ability to do the things I love. I’m in a competitive bowling league. I play golf. I ride my bike,” said Steve Squires, 46, of Middlebury, Indiana, who had the procedure in 2015 as part of the pilot study.
Squires noted that while focused ultrasound isn’t a cure for Parkinson’s, it helped him return to many of his normal activities. “It also gave me a platform to share with others who have Parkinson’s that there are new treatment optionsyou don’t have to suffer this alone,” he said.
Component #3 Some Form Of Restorative Therapy
Once the condition has been slowed/halted and a neuroprotective/nurturing environment is in place to protect the remaining cells , a curative treatment for Parkinsons will require replacing some of the cells that have been lost.
And until we have developed methods that can identify Parkinsons long before the motor features appear , some form of cell replacement therapy is required to introduce new cells to take up lost function.Cell transplantation currently represents the most straight forward method of cell replacement therapy.
Traditionally, the cell transplantation procedure for Parkinsons has involved multiple injections of developing dopamine neurons being made into an area of the brain called the putamen . These multiple sites allow for the transplanted cells to produce dopamine in the entire extent of the putamen. And ideally, the cells should remain localised to the putamen, so that they are not producing dopamine in areas of the brain where it is not desired .
Targeting transplants into the putamen. Source: Intechopen
Transplanted dopamine neurons. Source: Sciencedirect
The transplanted cells take several years to develop into mature neurons after the transplantation surgery. This means that the actually benefits of the transplantation technique will not be apparent for some time . Once mature, however, it has also been demonstrated that these transplanted cells can produce dopamine.
I think we are done.
Rapid Reversal Of Symptoms
Focused ultrasound is a completely incisionless procedure, performed without the need for anesthesia or an in-patient stay in the hospital. Patients, who are fully alert, lie in a magnetic resonance imaging scanner, wearing a specialized energy conversion helmet for the procedure. Ultrasonic energy is targeted through the skull to the globus pallidus, a structure deep in the brain that helps regulate voluntary movement. MRI images provide doctors with a real-time temperature map of the area under treatment.
Often before the procedure is even completed, patients experience relief from severe symptoms such as tremors, rigidity in the legs and arms, and side effects from medications that cause involuntary, erratic movements called “dyskinesia.”
About one million Americans have Parkinson’s disease, a neurodegenerative disorder that affects brain cells or neurons in a specific area of the brain that produce the brain chemical dopamine. Other current treatments for Parkinson’s include medications and deep brain stimulation from surgically implanted electrodes.
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.”
Two Landmark Studies Advance Focused Ultrasound Treatment For Parkinsons Disease
These two studies are a critical first step in using focused ultrasound to treat the underlying causes of Parkinsons
José Obeso, MD, PhD, of of the Centro Integral de Neurociencias in Madrid and Nir Lipsman, MD, PhD, of Sunnybrook Health Sciences Centre in Toronto. Each doctor is leading a clinical trial using focused ultrasound to target the striatum in patients with Parkinsons disease.
October 30, 2020 A team of researchers in Madrid, Spain, and another team in Toronto, Canada, are the first in the world to use focused ultrasound technology to target a new area of the brain in patients with Parkinsons disease and potentially curb, or even reverse, its progression.
Both ongoing clinical trials focus on the striatum, a hub of neurons deep in the brain that is one of the principal components of the basal ganglia an area that plays a central role in facilitating voluntary movement. The severity of movement-related symptoms of Parkinsons is associated with the neurodegeneration of dopaminergic nigrostriatal projection.
Focused ultrasound has previously gained international regulatory approvals for the treatment of tremor-dominant Parkinsons, including US Food and Drug Administration approval in 2018. The trials in Madrid and Toronto represent the first application of the technology with the goal of stopping the progression of Parkinsons, rather than merely treating the symptoms.
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Fda Approval Clears Way For Incisionless Brain Surgery As An Effective Non
A non-invasive ultrasound treatment for Parkinsons disease that was tested in a pivotal trial led by University of Maryland School of Medicine researchers is now more broadly available at the University of Maryland Medical Center . Recent FDA approval of a device used in the procedure effectively opens up access to focused ultrasound beyond clinical trial participation.
The device, called Exablate Neuro and manufactured by Insightec, was approved in late 2021 by the U.S. Food and Drug Administration to treat advanced Parkinsons disease on one side of the brain. UMMC is one of only several sites in the Mid-Atlantic region with the capabilities and expertise to perform focused ultrasound for Parkinsons disease and other movement disorders. The procedure requires a multi-disciplinary team, including a neurosurgeon, movement disorder neurologist, and neuroradiologist.
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Patient Story: Focused Ultrasound And Parkinsons Disease
It all started with a tiny tingle and I worried it was a sign of something bigger.
I was at a chili taste-testing contest when I reached to pick up a glass of hot apple cider and my baby finger tingled.
In that moment, I was concerned it was Parkinsons disease.
I had a feeling because my dad had had Parkinsons.
Over time I began noticing changes. My hand and arms started to tremor and my handwriting got progressively worse.
When my neurologist first gave me my diagnosis, I didnt want to believe it was Parkinsons. I wanted to fight it and beat it.
I still do.
Right now, there is no cure for Parkinsons disease. Its a progressive disease and its symptoms such as stiffness and tremor worsen over time. Each person with Parkinsons disease, experiences it differently.
For me, living with Parkinsons is a challenge. My main symptom is dyskinesia, which can include fidgeting or body swaying. My body isnt always doing exactly what I want it to do. Each day is different and depends on how my body is reacting to the medication that Im taking to help ease my symptoms.
I ended up retiring early from my job as a private school secretary. Day-to-day tasks take a bit longer to do, but I want to do things myself and I just take breaks when I need to.
The first participant of a world-first clinical trial
While some parts of my life are different, what hasnt changed for me is how determined I am to help in the search for a treatment or cure for Parkinsons disease.