“Rule, Britannia! Britannia rule the waves…Britons never will be slaves”
You may not be familiar with the words of Rule, Britannia, an eighteenth century British patriotic song, but you would undoubtedly recognize the tune. It was written when the British navy dominated the globe, and is a proud statement of freedom.
As anyone with essential tremor (ET) knows, when symptoms become severe, one literally becomes enslaved. The need for medication—which doesn’t really help about half of those who take it—and the challenges of eating, dressing, grooming, etc. are realities that take over a person’s quality of life. In short, ET deprives a person of his or her freedom to lead a normal life.
It is estimated that about a million British people have ET, and that roughly 200,000 of them suffer serious impairment because of it. Now that number may soon begin to drop.
England is one of the four countries that make up the United Kingdom, or UK (including Scotland, Wales and Northern Ireland). Each country is served by its own National Health Service (NHS), the publicly funded national healthcare system. If you have ET and live somewhere in the UK, the NHS will cover your medical care. If your ET does not respond to medication, the NHS will pay for a surgery called Deep Brain Stimulation (DBS).
MRI-guided Focused Ultrasound clinical trial in England
Currently, only one site in the UK offers a noninvasive alternative to DBS called MRI-guided Focused Ultrasound, or MRgFUS. It is St. Mary’s Hospital in London, a venerable institution that is one of the largest NHS trusts in England; together with Imperial College London it also forms an academic health science centre.i Thanks to funding help from Imperial Health Charity, St. Mary’s is the first center in England to acquire the award-winning MRgFUS technology from its manufacturer, Insightec.
Thus equipped, St. Mary’s was able to participate in a clinical trial of noninvasive MRgFUS to treat up to 20 ET patients. A December, 2016 news story reported some early results and observations, including a quote from one of the first patients treated: “Since the treatment I have been able to write my own name for the first time in many years and taken my wife out for a lovely meal without fear of embarrassing myself. I will also be able to go back to using my right hand which will allow me to take on more painting and decorating jobs.”ii As of June, 2018, 16 patients have now been successfully treated.
The trial’s success is so compelling, in fact, that the Imperial Health Charity plans to upgrade St. Mary’s imaging center and purchase an additional scanner dedicated to treating ET. If you read my blogs, you may recall my tale of Mary Ramsay, a Scottish grandmother who underwent DBS. Realizing that the invasive nature of DBS might deter others with ET, and that St. Mary’s was too far for local patients to reach, she launched a virtual one-woman campaign to bring MRgFUS to Scotland. Her efforts so far have not borne fruit, but perhaps the enthusiasm building in London will help her cause along.
According to a recent London Evening Standard news story, Professor Wladyslaw Gedroyc, a consultant radiologist at Imperial NHS trust, said the treatment had been shown to be “life-changing” for patients with essential tremor. “Seeing one of these successful procedures is as close as you can get to a medical miracle.”iii
MRgFUS at Sperling Neurosurgery Associates
Sperling Neurosurgery Associates offers incisionless MRgFUS for the treatment of medication-resistant ET. Using real-time MRI imaging, ultrasound waves are guided through the skull to destroy a very small part of the thalamus. By doing so, it effectively interrupts what is called the “tremor pathway” which carries the abnormal signals that cause involuntary shaking. There is no risk of infection or implants that can become dislodged, as with DBS. There are few-to-no side effect risks, and the results restore quality of life.
We congratulate St. Mary’s Hospital on the success of their clinical trial, and we welcome the news that soon MRgFUS will soon unchain more people from the slavery of severe ET.