Beyond Essential Tremor: The Future of MRgFUS in the Brain

MRI-guided Focused Ultrasound (MRgFUS) is a revolutionary treatment for Essential Tremor (ET). It destroys a very small “relay station” deep in the brain that forwards abnormal signals to the hands and other areas. A list of its attributes and advantages hardly does it justice: outpatient, noninvasive, safe, immediately effective, durable results, life transforming, FDA-approved, and radiation free. In fact, professional enthusiasm over this tremor-control modality continues to grow, and with it, increasing research and development into how MRgFUS can be applied to other neurological conditions. Here are a few examples that are in clinical studies:

  1. Parkinson’s disease – This degenerative condition destroys brain cells and neurons that affect muscle control. Tremors are a common first symptom, and gradually get worse. In addition, the drugs used to help patients can create a side effect called dyskinesia, or involuntary large muscle movements. The tremors and dyskinesia arise in slightly different areas of the brain than ET tremors, and clinical studies are demonstrating that MRgFUS can be used to destroy a small area that is causing the problem.
  2. Alzheimer’s disease – Another degenerative condition, Alzheimer’s, affects cognitive function in a way that patients gradually lose their memory and recognition, as well as suffer mood and personality changes. While there are current and experimental drugs to try to relieve symptoms and slow progression for early stage disease. MRgFUS is now being tested to see if it can “open” the blood-brain barrier (BBB) to allow more antibodies directly into the brain for greater effect. No drugs are yet being used in the early clinical trial, which is testing safety and effectiveness as well as identifying potential side effects.
  3. Epilepsy – This is a condition that causes different types of seizures. In many cases, medication is highly effective for controlling seizure activity. However, when medication does not work or is not an option, physically intervening in the brain itself can be done with surgery or radiation. The problem is that surgery is invasive, involving drilling a hole in the skull and inserting instruments; and radiation is not immediately effective (there is a “latency period” before success is known) and there is a risk of damaging the DNA of nearby healthy tissues. For epilepsy patients, powerful MRI scans can help identify the abnormally functioning brain area (epileptogenic zone), and MRgFUS can destroy that area to block the dysfunctional signals.
  4. Benign brain tumors in children – There are rare noncancerous tumors that arise in children’s brains, and centrally-located tumors can be difficult to access for treatment. Thanks to MRI guidance, and the nature of Focused Ultrasound, the tumor can be visually identified, and treatment to aim the “beams” of soundwaves into the target can be planned and carried out. Since no skin is broken and there are no holes in the skull, there is almost no risk of infection. Also, adjacent structures are not affected – only the tumor is destroyed.
  5. Psychiatry – MRgFUS is in clinical trials for the treatment of obsessive compulsive disorder (think of endless repetitive handwashing, housecleaning, etc.). By ablating (destroying) the area of the brain that is causing this behavior, repetitive thoughts and actions are able to be better managed with or without medication. In addition, MRgFUS has been or will be in clinical trials for the treatment of clinical depression that is not responding to medication, as well as anxiety disorders.
  6. MRgFUS at the Sperling Neurosurgery Associates

    Currently, the Sperling Neurosurgery Associates offers FDA-approved Neuravive, an ET treatment using MRgFUS. As the FDA gradually approves MRgFUS for other conditions, our Center is well-prepared to implement this treatment. (Note that we also use MRgFUS to treat metastatic bone tumors, and chronic back pain due to facet joint arthritis.)

    There are many more conditions that arise in the brain that may be able to be treated with MRgFUS. As brain anatomy and function/malfunction are better understood, so too are the possibilities for MRgFUS. Thus, our doctors and staff like to think of Focused Ultrasound is the (Sound)Wave of the Future.

    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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