How often does this scenario occur? Someone with a chronic condition that is not life-threatening – let’s say migraine headaches – has been seeing doctors for years. There has been a succession of drugs, second opinions, alternative therapies, but the migraines still happen. Then the patient hears an ad for an exciting new treatment that can stop migraines in their tracks. At the next doctor visit, the patient asks about this innovation. The doctor says, “I hate to sound like a skeptic, but if it sounds too good to be true, it probably is. I couldn’t recommend it unless I knew for sure that it’s performs as good as or better than what we’re already doing. Besides, who knows what harm it might cause?”
Perhaps, for many patients and doctors, MRI-guided Focused Ultrasound (MRgFUS) for Essential Tremor (ET) sounds too good to be true. A noninvasive, outpatient treatment with no drugs, surgery or radiation that controls tremors? A Doubting Thomas might ask, “If it really exists, how does it stack up against existing brain treatments?”
A new study (Kim et al, 2017i) does an excellent job of answering that question. Although the study was relatively small with only 59 patients, its purpose was to compare MRgFUS with radiofrequency (RF) thalamotomy and Deep Brain Stimulation (DBS) as a treatment for ET that does not respond to medication. Participants were divided into three roughly equal groups:
- RF – 17 patients
- DBS – 19 patients
- MRgFUS – 23 patients.
The outcomes that were measured were how successfully the treatment controlled tremor, and complications related to treatment. Results were reports at 1 month and again at 12 months after treatment. The following table summarizes findings:
| MRgFUSii | DBSiv | RFiv | |
|---|---|---|---|
| Success at 1 month | 91.3% | 89.5% | 100% |
| Success at 1 year | 78.3% | 84.2% | 70.6% |
| Side effects at 1 month | 13.0% | 5.3% | 58.8% |
| Side effects persist at 1 year | 4.4% | 21.1% | 11.8% |
Interpreting the numbers
RF – the first thing that leaps out is the 100% success of RF at one month, but notice that by a year after treatment success dropped to just over 70%. Also, at one month, RF had the highest rate of complications, though that tapered off to 11.8% by one year.
DBS – The one-month success of DBS (almost 90%) of DBS did not diminish much. At one year, it was still an impressive 84.2%. However, it had the highest rate (21.1%) of persistent complications and side effects at the end of 12 months.
MRgFUS – At one month after treatment, patients who had MRgFUS reported 91.3% success, which dropped 13% over 12 months to 78.3%. On the other hand, the authors point out that at 4.4%, “complication rates…were lowest in the MRgFUS group.”
To sum up, this is a great study to bring to the attention of doctors who are skeptical of MRgFUS as a treatment for ET. Besides the high rate of durable success and very low rate of persistent complications, the treatment advantages include:
- No incisions or holes drilled into the skull
- No radiation
- Conscious during the procedure
- Success is immediate
- Recovery is very rapid
Sperling Neurosurgery Associates is proud to offer the Neuravive MRgFUS procedure under the guidance of a powerful, state-of-the-art magnet. If you or a loved one suffers from lifestyle-impairing ET, contact us for more information.
iKim M, Jung NY, Park CK et al. Comparative evaluation of magnetic resonance-guided focused ultrasound surgery for essential tremor. Stereotact Funct Neurosurg. 2017 Aug 16;95(4):279-286.
iiKim M, Jung NY, Park CK et al. Comparative evaluation of magnetic resonance-guided focused ultrasound surgery for essential tremor. Stereotact Funct Neurosurg. 2017 Aug 16;95(4):279-286.
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.