Focused Ultrasound for Essential Tremor (ET) and Tremor Dominant Parkinson’s Disease (TDPD)
What is Focused Ultrasound?
Focused Ultrasound is an incisionless treatment for patients with Essential Tremor (ET) and Tremor Dominant Parkinson’s Disease (TDPD) who have not responded to medication. It uses high intensity ultrasound waves guided by MRI to treat deep areas in the brain associated with tremor, with no permanent implants or general anesthesia. There is little to no risk of infection and patients usually return home the same day with immediate tremor improvements.
Focused ultrasound targets a small brain area called the ventral intermediate nucleus, which is a crucial relay station for tremor-related signals. This precise targeting is a crucial aspect of its efficacy in reducing tremors. During the procedure, the patient is lying on a table and moves in and out through an MRI. The MRI enables the physician to visualize a patient’s brain anatomy, plan, and target the area for treatment. It also acts like a thermometer, providing continuous temperature monitoring to verify that only the targeted tissue is destroyed. As the temperature at the brain target rises, it creates a small ablation or burn, providing a therapeutic effect.
While treatment of hand tremors is the goal of focused ultrasound, it may also provide some degree of tremor relief for the head and voice.
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How Does Focused Ultrasound Work?
The FUS procedure works as follows:
- The procedure is completed, and the patient is typically monitored for a short period before being discharged.
- The patient’s head is shaved to ensure efficient transmission of ultrasound waves.
- The patient undergoes an MRI to identify the specific brain area responsible for tremor.
- The patient’s head is secured in a frame to ensure precise targeting.
- The patient is positioned in a focused ultrasound machine, similar to an MRI scanner.
- Ultrasound waves are directed at the target area in the brain through the intact skin and skull.
- The energy from the ultrasound waves heats and ablates the targeted brain tissue, altering its activity to reduce tremor.
- Throughout the procedure, MRI imaging is used to monitor the effects and adjust the ultrasound beam as needed.
- The patient may be asked to perform tasks or movements during the procedure to evaluate tremor improvement.
- The entire procedure usually lasts between 3 to 4 hours. This includes preparation, imaging, treatment, and immediate post-procedure monitoring.
Medical Indications
- Medication-Refractory Tremor: Patients with ET or TDPD who have not adequately responded to medication may be considered.
- Severe Tremor Impacting Quality of Life: Candidates typically have tremors that significantly affect their daily activities, work, and social interactions, thereby impairing their quality of life
- Patient Preference: Particularly suitable for patients who prefer less invasive procedures and patients who want to avoid the upkeep of an implantable device.
- Contraindications for Surgery: Patients who cannot undergo surgical procedures due to medical contraindications may be eligible, as it avoids surgical risks such as infection and bleeding.
- Treatment of Unilateral Symptoms: The treatment is FDA approved for staged unilateral treatment – treating one side at a time with at least 9 months between treatments for eligible patients and without significant clinical events from the first treatment.
- Assessment and Diagnosis: Patients are typically assessed to ensure that their tremor symptoms are primarily caused by ET or TDPD and no other neurological conditions, ensuring accurate diagnosis and treatment.
Benefits & Expected Outcomes
Incisionless Focused ultrasound does not require incisions, general anesthesia, nor surgical implants, reducing some of the risks inherent to more invasive procedures.
- Outpatient Setting: The procedure is usually performed in an outpatient setting, eliminating the need for hospital stays.
- Precision: The technology allows for precise targeting, minimizing damage to surrounding tissues.
- Safety Profile: Focused ultrasound generally has a favorable safety profile with relatively few serious adverse effects.
- Rapid Recovery: Patients often experience a rapid recovery with minimal downtime, sometimes resuming normal activities within days.
- No Permanent Implants: Unlike deep brain stimulation, which involves placing permanent electrodes in the brain, focused ultrasound does not leave any implants, thus avoiding long-term maintenance issues and the need for device programming.
- Immediate Effects: Many patients experience an immediate reduction in tremor severity following the procedure, providing rapid symptomatic relief.
- Improvement in Quality of Life: By alleviating tremor symptoms, patients often report improved quality of life, including better social interaction and reduced dependency on others for daily tasks.
- Sustained Benefits: Clinical studies have shown that many patients maintain the benefits of tremor reduction for a prolonged period following treatment, although ongoing monitoring is recommended.
Potential Side Effects & Complications
While focused ultrasound is generally safe, there are potential side effects and complications that patients should be aware of:
- Temporary Side Effects: Some patients may experience temporary effects such as numbness, tingling, imbalance, headache, nausea, or discomfort in treated areas. These symptoms usually resolve after a few days to weeks.
- Permanent Side Effects: A small percentage of patients are at risk of permanent side effects, which may include numbness, tingling, balance issues, or other neurological changes
- Uncommon Serious Complications: Although rare, there is a potential for severe complications such as scalp burn, brain hemorrhage, and speech or swallowing changes. Each patient’s risk of side effects and complications can vary based on their medical history, condition severity, and other health factors.
- Long-Term Monitoring: Ongoing follow-up is necessary to assess the durability of tremor reduction and manage any emerging side effects.
- Failure to Achieve Desired Tremor Reduction: Some patients may not experience the anticipated level of tremor improvement, necessitating additional interventions.
Potential Side Effects & Complications
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