2020-12-16T15:39:52-06:00February 2nd, 2021|

Ask the Experts: How does focused ultrasound compare to other treatments for essential tremor and tremor-dominant Parkinson’s disease?

Focused Ultrasound is a new treatment for hand tremors that is being offered at our East Campus.

It’s an alternative to medications, which don’t work for as many as 50 percent of patients. It’s also a way to avoid invasive surgery that can carry risks and a difficult recovery.

Focused Ultrasound involves no incision or hospital stay, and most patients experience immediate, lasting relief with few side effects.

Regional One Health is offering a new path to relief from essential tremor and tremor-dominant Parkinson’s disease: MR-Guided Focused Ultrasound, an incisionless outpatient procedure that can deliver major, lasting improvements to hand tremors in just a few hours.

Focused ultrasound is an alternative to medications, which don’t work well for up to 50 percent of patients; and to surgery, which can bring risks and extensive recovery.

Neurosurgeon Aaron Bond, MD provides the treatment at Regional One Health’s East Campus Imaging Center, one of just a handful of locations in the United States where it is available. He said it’s a good option for patients who don’t respond to medication and want to avoid surgery.

“In my experience working in the Memphis area, many patients with essential tremor are either undiagnosed, or are treated by their primary care physician and not a neurologist specializing in movement disorders. Patients assume their tremor is a sign of old age and don’t realize there are treatments out there which can potentially eliminate their tremors,” he said.

“People living with hand tremor from essential tremor and Parkinson’s Disease now have access to an incisionless outpatient treatment option,” said neurosurgeon Dr. Aaron Bond.

“People living with hand tremor from essential tremor and Parkinson’s Disease now have access to an incisionless outpatient treatment option.”

During focused ultrasound, patients lie on a treatment table that moves in and out of an MRI over the course of several hours. They have their head shaved and wear a fitted helmet, allowing the ultrasound waves to pass through their skull.

The MRI acts the “eyes” of the treatment, allowing Dr. Bond to plan, guide and target the correct area of the brain. He focuses the ultrasound waves through the helmet to the VIM nucleus of the thalamus, which is the portion of the brain that causes the tremor.

Ultrasound energy passes safely through skin, muscle, fat and bone with no incision, and it does not expose patients to radiation. The ultrasound waves create a tiny burn that has a therapeutic effect, and the MRI monitors temperature to ensure only targeted tissue is destroyed.

Patients perform tests, like drawing a spiral, throughout the procedure to make sure it is working. Most patients have immediate tremor relief, and studies show improvements last for years.

Some patients experience mild nausea or pain during the procedure, and side effects afterwards include a small risk of muscle weakness, unsteadiness when walking, sensory loss and numbness and tingling in the fingers and elsewhere.

However, since there are no incisions or implants, the risk for infection is minimal and recovery is easy. Most patients go home shortly after treatment and resume normal activities within days.

Prior to having focused ultrasound, patients are required to first try essential tremor medications. Medication is the frontline treatment for essential tremor, and it can manage symptoms for many patients. However, an estimated 30-50 percent don’t get relief or suffer unpleasant side effects.

Beta-blockers can cause slow heart rate, blood pressure drops, fainting, fatigue and depression. They may not work for patients with asthma, diabetes, depression, certain heart conditions or liver or kidney disease. Pregnant and nursing women also may not be able to take beta-blockers.

During the Focus Ultrasound procedure, patients lie on a treatment table that moves in and out of an MRI. Ultrasound waves are used to treat the portion of the brain that causes tremor.

Anti-seizure medications can have side effects like dizziness, nausea, difficulty walking, fatigue and confusion, but they usually diminish over time. Patients may not be able to use them if they are pregnant or nursing or have kidney, liver or blood count problems.

There are also surgical options for essential tremor, including deep brain stimulation (DBS) and thalamotomy.

DBS involves surgically implanting permanent electrodes in the brain and a pulse generator in the chest. That allows the VIM nucleus to be stimulated, providing relief for the tremor. DBS is highly effective but carries the risks of surgery and requires lifelong follow-up care including stimulation adjustments and battery replacement.

Thalamotomy requires making an incision in the scalp and drilling a small hole in the skull, then inserting a radiofrequency probe to heat and create a lesion in the thalamus. Again, the procedure typically gets good results, but does have the risks of surgery.

The only other incisionless option for essential tremor, a Gamma Knife procedure, involves exposure to radiation. Instead of using ultrasound waves, it targets the VIM nucleus with beams of radiation to create the therapeutic ablation. Unlike with focused ultrasound, relief is not immediate – it may take months to see results.

Visit www.regionalonehealth.org/east-campus-imaging-services/essential-tremors/ to request a consultation and learn more about our focused ultrasound service.