Essential tremor (ET) is the most common movement disorder around the globe. At an estimated 4% of adults over age 40, there are currently over 300 million persons worldwide who are living with ET. Throughout history, tremors have been recognized and described primarily as an aging-related condition, but we can hypothesize that healers were consulted in hopes of finding remedies for severe tremors. Perhaps herbs or primitive “procedures” such as bleeding or leeches were used; or maybe shamanic ceremonies were performed. If so, it’s extremely unlikely that anything worked.
Nowadays, virtually every nation and culture has access to medications and sophisticated, hi-tech neurosurgical procedures to control ET. This includes a breakthrough treatment called MRI-guided Focused Ultrasound (MRgFUS) that has gained international recognition. The outpatient, noninvasive procedure focused beams of ultrasound into the brain to accomplish what is called a thalamotomy. The thalamus is a small part of the brain that does many things, including orchestrating movement messages to various body parts. A very tiny center in the thalamus called the VIM nucleus acts as a gateway for signals to the hands. If the signals are abnormal, as is the case in ET, the affected hand will move abnormally. The purpose of MRgFUS is to ablate (destroy) the VIM nucleus. This effectively blocks the abnormal signals without affecting normal movement.
From a patient’s viewpoint, a key benefit of MRgFUS is its noninvasive approach. There are no incisions or holes drilled in the skull, so no risk of infection or bleeding in the brain. Best of all, it is immediately effective. By the time the procedure is over, tremors in the treated hand (the dominant side) are gone.
ET in Taiwan
The country of Taiwan is an island nation off the coast of mainland China. With a population of over 23 million, it is estimated that nearly one million people in Taiwan have ET. Though much smaller than the U.S, Taiwan is recognized as a competitive, innovation-driven player on the world stage. An article in Forbes reports, “Taiwan has a 98.5% literacy rate, the fourth highest standardized math test scores in the world (according to the Organization for Economic Development) and over 25% of all university degrees are in engineering.”i
Engineering (hardware and software) is a vital component of today’s medical devices, including MRgFUS. It is no surprise, therefore, that top academic medical centers in Taiwan would look to the most advanced therapies for disease conditions. MRgFUS is a perfect example. A poster presentation at the 2018 International Congress of Parkinson’s Disease and Movement Disorders reveals the professional enthusiasm over MRgFUS as new hope for those with ET.
The authors note that of the nearly 1 Taiwanese estimated to have ET, 60% are refractory to medication, meaning that pharmaceuticals like propranolol or primidone are not effective. Their poster summarizes a small but important study of 10 participating patients with confirmed refractory ET. Before treatment, all participants were given psychological and quality of life questionnaires, as well as their tremors evaluated on standard tremor scales. After treatment, the team reported, “Our results suggested that MRgFUS thalamotomy could significantly improve the tremor control and life quality of refractory ET patients in Taiwan,” and that MRgFUS is “a promising tool to improve tremor control and life quality of variety of movement disorders in Taiwan.”ii
Since ET not only affects the activities of daily life but also social interaction, finding universally effective treatment is important. In addition to their own study, the authors also note that their review of previously published findings “suggest that MRgFUS thalamotomy has more benefits than other surgical approaches“in the treatment of ET. In shore, Focused Ultrasound has the potential to make life better for people with ET in Taiwan—and around the world.
Our own experience
At Sperling Neurosurgery Associates, our own experience is identical to that of our Taiwanese colleagues. Our patients not only regain the use of their dominant hand, their quality of life skyrockets.
It is a privilege to have the same sophisticated technology used for the Taiwanese study in order to restore personal, professional, recreational and social opportunities for our patients. We invite you to browse our patient testimonials to listen to what our patients say, or contact us for a consultation.
iGreenwald, Michelle. “How Taiwan Is Reinventing Its National Culture From Manufacturing Efficiency To Innovation And IP.” Forbes, Feb. 7, 2017. https://www.forbes.com/sites/michellegreenwald/2017/02/07/how-taiwan-is-reinventing-its-national-culture-from-manufacturing-efficiency-to-innovation-ip/#34d23bef6650
iiH.C. Lai, K. Tsai, W.C. Chang, T. Taira, C.Y. Wei. 5 Improvements of tremor control and life quality of refractory essential tremor patients after MRguided focused ultrasound thalamotomy – A Taiwan experience. Poster #5. International Congress of Parkinson’s Disease and Movement Disorders, Hong Kong. Oct. 5-9, 2018. https://www.mdscongress.org/Congress-2018-Files/Abstracts/GuidedPosterTourAbstracts.pdf