Involuntary, uncontrollable tremors (rhythmic shaking or quivering movements) of the hands, head or other body parts can range from mild to severe. They may or may not respond to medication, and when they worsen, they diminish quality of life. Not only do they interfere with normal daily activities like feeding, bathing, dressing, writing or typing, etc., they can diminish a person’s self-esteem and confidence through embarrassment and vulnerability. If these feelings become extreme, many persons choose isolation as a way to avoid the judgments and assumptions of others.
Parkinson’s disease (PD) is a neurodegenerative condition that typically has tremors as its first identifiable symptom. For patients with tremor-dominant PD, medications are the first line of treatment, and include “levodopa, dopamine agonists, anticholinergics, botulinum toxin, clozapine, amantadine, clonazepam, propranolol, and neurontin…”1 However, in many cases the drugs lose effectiveness. In addition, the standard of care drug, levodopa, may eventually cause a complication called dyskinesia, “…an abnormal, uncontrolled, involuntary movement. It can affect one body part, such as an arm, leg or the head, or it can spread over the entire body. Dyskinesia can look like fidgeting, writhing, wriggling, head bobbing or body swaying.”2
When tremors no longer respond to medication, and/or dyskinesia becomes difficult to tolerate, a patient’s physician may recommend a brain intervention called Deep Brain Stimulation (DBS). DBS involves implanting electrodes deep in the brain that interrupt the abnormal tremor signals using a mild electric current. The elements of DBS include
- A surgery to drill a hole in the skull and implant the electrodes in the area of the brain that relays tremors to the limbs
- Another surgery to implant a small power pack in the chest area and wires from the pack that pass through the neck to connect to the electrodes
Although DBS has been proven effective in the majority of cases, many patients are scared off by the thought of drilling into the skull, implanted wires, and risks of side effects such as infection and even stroke.
MRgFUS – an alternative to DBS
There is a new noninvasive treatment for tremors called MRI-guided Focused Ultrasound (MRgFUS). It is done inside the bore (tunnel) of the MRI scanner. This treatment uses tiny beams of ultrasound (sonic energy) from many different directions, all focused on the specific area of the brain from which the dysfunctional signals are coming, whether tremors or dyskinesia. The sonic energy passes harmlessly through the skull and intervening tissue, but when they converge precisely on the target, they generate enough heat to destroy the area. Not only is MRI imaging used to identify and target and plan delivery of the ultrasound, it is also used to monitor the lethal temperature in real time through special “thermography” software. The use of MRI guidance assures accuracy, and thermal monitoring allows the “dosage” of ultrasound to achieve the correct temperature without creating collateral damage to nearby structures.
The effectiveness of the treatment is immediately apparent, and since it is an outpatient procedure, patients return home the same day. Recovery is rapid, and the risk of side effects is minimal-to-none.
Is MRgFUS available for Parkinson’s disease in the U.S.?
Although MRgFUS is used in Europe to treat PD tremors, in the U.S. it is being studied in clinical trials for this application. The U.S. Food and Drug Administration (FDA) has already approved MRgFUS for the treatment of Essential Tremor (ET), and Sperling Neurosurgery Associates provides this application.
We are ready for approval
According to Schlesinger et al. (2017)3, “MRgFUS is a new option for PD patients with medication resistant symptoms. It is approved for this indication in Israel, Europe, Korea, and Russia. Further studies are needed in order to better characterize patient selection and treatment targets.” Although the FDA often relies more on study data generated here in the U.S., at Sperling Neurosurgery Associates we are optimistic that, because of the Westernized nations that already approve of MRgFUS for PD symptoms, the path to approval here has at least been opened.
When that day comes, we are fully prepared with the Neuravive MRgFUS system and a staff of caring experts. Hopefully, approval is coming soon.
1Schlesinger I, Sinai A, Zaaroor M. MRI-guided focused ultrasound in Parkingon’s disease: a review. Parkinson’s Disease. Volume 2017 (2017), Article ID 8124624.https://doi.org/10.1155/2017/8124624
3 Schlesinger, I et al. Ibid.