Reaction To The Research
Sandeep Thakkar, DO, heads the Parkinsons and movement disorders program at the Pickup Family Neurosciences Institute in Newport Beach, California.
He says how long the ultrasound treatment is effective is debatable, but its effectiveness typically goes beyond what medications can accomplish.
We have very few medications that work and, even if they do, its short term, Thakkar told Healthline.
Jean-Philippe Langevin, MD, a neurosurgeon at Providence Saint Johns Health Center in Santa Monica, California, calls the study pretty significant.
This is mainly for patients with tremors in their upper extremities, who have trouble eating, getting dressed, things like that, medications for which dont work very well, Langevin told Healthline.
Theres a number of patients who dont want the . It could be theyre turned off by the thought of having an implant. The ultrasound treatment can be less invasive, he said.
Langevin adds that some of the risks associated with surgery are significantly reduced, although by destroying part of the thalamus, there can be risk of a person experiencing pins and needles sensations.
There can also be problems with speech. It can be garbled, he noted.
Ninety to 95 percent of people are not going to have side effects, Langevin said. Its not the entire thalamus . Its just a tiny portion.
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World First: Focused Ultrasound Opens Blood
In a groundbreaking, world-first clinical trial, a team of researchers from Sunnybrook Health Sciences Centre and University Health Network are using focused ultrasound technology to deliver a therapeutic directly to affected brain regions in patients with Parkinsons disease .
Parkinsons affects more than 6 million people around the world. It is a brain disorder that causes tremor, rigidity, slow movement and numerous other disabling symptoms. PD is a progressive neurodegenerative disease currently without a cure, which dramatically impacts a patients quality of life. Each patients symptoms can progress at a different rate.
Focused ultrasound harnesses the power of ultrasound waves to reach deep brain regions without the need for scalpels or cutting. In this study, researchers are using low intensity MRI-guided focused ultrasound to open the blood-brain barrier, which protects the brain from toxins but can also block potentially helpful medications.
The goal of this Phase I trial is to examine the safety of temporarily opening the blood-brain barrier in key motor regions known to be implicated in Parkinsons disease as well as delivering promising therapeutics directly to these areas of the brain, says Dr. Nir Lipsman, the studys co-principal investigator and Director of Sunnybrooks Harquail Centre for Neuromodulation.
Breaking New Ground With Hifu
The multidisciplinary approach extends to new applications for HIFU, as Dr. Mogilner and Dr. Shepherd investigate new uses in the context of tremor associated with other conditions, while shedding light on factors that optimize the treatments efficacy for all patients.
In one study, Dr. Shepherd and team are investigating factors that contribute to individual variability in procedure times and patient outcomes. The researchers are applying novel imaging sequences to pre- and post-HIFU MRIs to compare patient outcomes both six weeks and six months after the procedure, with the goal of identifying imaging markers associated with clinical progress or side effects. We want to better understand the factors that impact patients individual recoveries, so we can uncover ways to further refine the procedure, says Michael H. Pourfar, MD, assistant professor in the Departments of Neurosurgery and Neurology, and the centers other co-director.
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Why Choose Us For Focused Ultrasound
UMMC is a pioneer in FUS treatment. We were among the first to offer FUS, and our hospital is one of only a handful nationwide with deep expertise in the procedure.
We directed the groundbreaking clinical trial research that led to FUS being authorized by the FDA for treatment of essential tremor. Our ongoing clinical studies are leading the way in FUS research toward making the procedure the new standard of care for treatment of Parkinsons, essential tremor, glioblastoma and other devastating brain diseases.
You will be in the excellent hands of UMMCs highly knowledgeable and experienced multidisciplinary team, which is made up of neurologists, neurosurgeons, diagnostic radiologists, neuroradiologists and neuropsychologists.
Advantages Of Mrgfus For Parkinsons Disease Tremors
In 2016, Forbes Magazine carried an article on MR-guided Focused Ultrasound for essential tremor . Citing positive results from clinical trials, the article explained that The treatment doesnt require any implants, incisions or ionizing radiationi. As the news spread, Parkinsons disease patients who also suffer from tremors wondered if MRgFUS could eliminate their tremors, too.
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Low Intensity Focused Ultrasound To Help Deliver Therapies
While high intensity FUS is a treatment for PD as described above, low intensity FUS can be used in an entirely different way to help treat PD. This type of FUS may allow for disruption of the blood brain barrier. The blood brain barrier refers to the cells that line the blood vessels within the brain which keep foreign substances, such as toxins and microbes, in the bloodstream and out of the brain.
Normally, this mechanism is advantageous and protects the brain. However, the blood brain barrier may also keep out molecules that could help to treat brain diseases. Therefore, disrupting the blood brain barrier could allow for penetration of these molecules into particular areas of the brain. A whole variety of different molecules such as antibodies, nerve growth factors and gene therapy may be able to take advantage of this approach. Further research is necessary to determine if this will be a useful method for drug delivery into the brain.
Dystonia And Deep Brain Stimulation
Dr. Justin Sporrer, the Director of Functional Neurosurgery Baptist Hospital at Miami. and Dr. Bruno V. Gallo, Medical Director of Movement Disorders, work collaboratively to bring relief to patients who suffer from Parkinsons disease, essential tremors, and dystonia. Under their direction, the first essential tremor and dystonia patients were treated with deep brain stimulation shortly after resuming elective surgeries in June. Through the careful placement of stimulation leads and skilled devise programming, these patients have experienced a tremendous reduction in disordered movement and significant improvement in the quality of life.
In addition to the expansion of DBS treatment, the functional neuroscience team is expanding their treatment options by bringing a new innovative technology called High-Intensity Focused Ultrasound to the Miami Neuroscience Institute . High-Intensity Focused Ultrasound is currently FDA approved for the treatment of patients with essential tremors and tremor-dominated Parkinsons disease. This venture began over a year ago and we are excited to announce our first patient will receive HIFU treatment later this month. This new treatment option will allow our skilled physicians to bring relief to more patients within our community.
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How Do I Know If I Am Eligible For Treatment
Your doctor is the best person to ask about this. He or she will be able to tell you if you are a suitable candidate. In general, people who cannot go into an MRI will not be able to go through the treatment this includes patients with metallic implants, patients who are claustrophobic and patients who are allergic to contrast agents a dye used during MR imaging, patients who are over 300 lbs and patients who are under 22 years of age.
- If you have any kind of metallic implants, such as pacemakers, neurostimulators, spine or bone fixation devices, total joints, metal clips, screws, etc., you may not be a candidate. Any metallic implants must be non-magnetic to prevent injury to the patient from the MRs strong magnetic field.
- If you are not generally healthy enough to withstand the treatment and lie still in the same position for approximately 3 hours, you may not be a suitable candidate for this treatment.
- If you have had a recent myocardial infarction or have congestive heart failure , unstable angina pectoris , or spinal conditions, are you should discuss these issues with your doctor.
- If you have extensive scarring on the scalp, you may not be a good candidate.
- If you have any tumors inside the skull, you may not be a good candidate.
- If you are on dialysis, you may not be a good candidate.
- If you have an active infection or severe hematological, neurological or other uncontrolled disease, you may not be a good candidate.
A New Approach To Reach Tremors Root Cause
Patients with essential tremor have traditionally been presented with a variety of invasive treatment options, including surgical ablation and deep brain stimulationboth of which target tremor by disrupting abnormal signaling in the thalamus.
HIFU similarly targets the thalamus, but instead uses a noninvasive focused ultrasound beam that creates a lesion, eliminating the abnormal signaling at the root of tremor and thus normalizing the regions circuitry. Candidates for the procedure typically have tremor symptoms that interfere with their quality of lifepersisting despite conservative treatment. Requiring only a few hours to complete, HIFU is a safer, noninvasive treatment option with a much lower risk of complications and minimal recovery time.
The safe use of HIFU requires close partnership between neurosurgeons, neurologists, and neuroradiologists in order to visualize brain response during the procedure. The ability to regulate temperature as you precisely target the tremor-inducing misfiring neurons in the thalamus is vital to avoid brain injury, notes Alon Mogilner, MD, PhD, associate professor in the Departments of Neurosurgery and Anesthesiology, Perioperative Care, and Pain Medicine and co-director of the Center for Neuromodulation. The combination of ultrasound with MRI thermography enables real-time visualization and temperature feedbackand makes HIFU both a safe and viable option for patients.
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Hifu Facelift Treatment Pros And Cons: Why Is It Getting Popular
For those who do not know, HIFU stands for High-Intensity Focused Ultrasound, an advanced cosmetic technology that significantly tightens and lifts several areas of the face.
It also reduces signs of aging and improves the tone of the skin in a single session.
HIFU Facelift is a long-lasting, non-surgical, non-invasive treatment that uses ultrasound energy to tighten and lift the skin.
Technical Information On Hifu
For the procedure using Haifu technology, special equipment and hardware are used. It is represented by a stereotaxic head frame , which is connected to an MRI-compatible ultrasound transducer . After stereotactic navigation using MRI, the ultrasound energy is sequentially calibrated to temperatures sufficient to ablate tissue . Each short-term ultrasound treatment is monitored by magnetic resonance thermometry, direct clinical assessment of tremor reduction and side effects is performed.
Before the procedure, the patient is trimmed bald because the space between the helmet and the head will be occupied by water. The standard and required size of the neural zone is 2 by 2 mm. This eliminates the possibility of damage to other parts of the brain. Ablation lasts only 7 seconds. The task is to exclude the work of a certain number of neurons forever, while not destroying neighboring neural circuits.
The whole process takes 2 hours. First, there is a brain scan, then image calibration and simulation. After that, the process of titration of temperatures is carried out with a gradual increase until a clinical effect appears. All this time, a neurologist is nearby, who constantly monitors and evaluates the clinical results, while the patient himself is conscious, no anesthesia is applied.
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Symptoms Abated A Patient Returns To Everyday Function
In a recent case, a 77-year-old retired physician traveled from North Carolina for consultation and treatment for his tremor, which had progressed over the course of 5 years with diminished response to standard medications, including beta blockers and primidone. He was experiencing increasing difficulty with regular functions such as writing, using a computer, or even holding a cup, and it was negatively impacting his everyday life by the time he reached us, says Dr. Mogilner.
Though the patient had considered deep brain stimulation surgery, typically the next line of treatment when conservative therapeutics fail, he was reluctant to pursue the invasive treatment due to his age. Now that theres a safer option available, the riskbenefit analysis made sense for him, so we proceeded with an evaluation to ensure his tremor warranted HIFU, says Dr. Pourfar.
During the procedure, Dr. Mogilner and the team assessed his progress, asking him to perform simple movements and report any weakness or tingling, as the ability to note observable outcomes is a key advantage of the procedure. With real-time MRI confirming that the target area would not evoke untoward side effects, Dr. Mogilner slowly increased the waves intensity to create a permanent lesion.
Research Into Focused Ultrasound
Ongoing research on focused ultrasound for Parkinsons is evaluating the procedure in different brain areas affected by Parkinsons, such as the subthalamic nucleus and the pallidothalamic tract. At the same time, scientists are looking at the possible benefits and safety of both-sided FUS in different targets as well as the best practices for performing this procedure.
Researchers also are studying how ultrasound could help other Parkinsons treatments, such as antibodies against alpha-synuclein or gene therapies, get into the brain more easily and efficiently by temporarily opening the brains protective barrier.
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Focused Ultrasound For Parkinsons Disease
Although elective procedures are currently being postponed in hospitals across the country because of the necessary focus on COVID-19, eventually our hospitals will return to normal and non-emergent procedures will be performed again. This will include elective procedures for the treatment of Parkinsons disease .
Two brain procedures that are approved for use in PD are deep brain stimulation and high intensity focused ultrasound . I encourage you to read more about DBS and view our webinar which outlines the newest features of this procedure.
Focused Ultrasound Ablation Of The Subthalamic Nucleus Of The Brain
Today, the HIFU technology should be considered a fundamentally new non-invasive treatment for Parkinsons disease. It involves the use of high-frequency concentrated ultrasound.
Today Spain has become one of the first countries in Europe where this technology exists and is already actively used. We are the only ones with effective experience in the treatment of Parkinsons disease.
This is a revolutionary and unique technology designed to treat patients with familial tremors. It has proven to be useful against one of the most common and still incurable movement disorders, Parkinsons disease. We also recommend that you familiarize yourself with Tremor Treatment.
The accumulated experience of the successful application of Haifu exists only in Valencia .
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What Neurologic Conditions Can Be Treated With Mr
The U.S. Food and Drug Administration has approved focused ultrasound for the following conditions:
- Essential tremor. MR-guided focused ultrasound is approved for the treatment of essential tremor that cannot be controlled with medication. Approval is for treatment of one side of the brain only. Patients must be at least 22 years of age.
- Tremor-dominant Parkinsons disease. MR-guided focused ultrasound is approved to treat patients with Parkinsons disease whose main symptom is tremor. Patients must be at least 30 years of age.
Use of MR-guided focused ultrasound is being explored for other neurologic conditions including the tremors associated with multiple sclerosis, epileptic seizures that cannot be controlled by other treatment approaches, other movement disorders, stroke, brain tumors and neuropathic pain. Treating these other conditions is considered experimental at this time.
How Else Do You Treat Parkinsons
Before the invention of the MRI-HIFU method, Parkinsons disease was treated primarily by medication and surgery. Even today, they are used in clinics specializing in the treatment of neurological diseases.
Medical treatment for Parkinsons disease
When diagnosed with Parkinsons disease, the first treatment prescribed by doctors is medication. Its the safest, most accessible and the cheapest method. The medication affects the level of dopamine in the brain. Usually, they are well tolerated by patients and side effects are controlled.
However, 30% of patients with Parkinsons disease are not medically treatable. To help them, doctors are using more invasive interventions.
Thalamotomy
The operation is very similar to the MRI-HIFU method. To reduce tremor, the doctor damages the necessary thalamus nucleus. Previously, this procedure was done only in the form of open surgery. Modern physicians prefer to use non-invasive methods such as radiofrequency, ultrasonic ablation or Cyberknife.
Deep brain stimulation is another modern method of treating Parkinsons disease. The doctor puts a small pacemaker-like device under the skin. It delivers electrical impulses to the brain that block or alters abnormal activity that causes symptoms.
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Delray Medical Center Is First Hospital In Region Offering New Incisionless Treatment Option For Parkinsons & Essential Tremor Patients
Delray Beach, FL Delray Medical Center is the first hospital in the region to offer a new scalpel-free treatment for essential tremor and medication-refractory tremor-dominant Parkinsons disease. MR-guided focused ultrasound by INSIGHTEC, uses sound wave energy to treat brain tissue at the source of the tremor. No surgical incision or anesthesia is necessary, and patients may experience immediate and significant reduction in their hand tremors, giving them a chance to get back to their daily activities.
This technology is a game changer in our community and for those seeking the very latest in cutting edge technology for neurologic care of Parkinsons disease, said Dr. Lloyd Zucker, chief of neurosurgery at Delray Medical Center. The future is bright for those who may be stricken with this neurological disease, as we can care for these patients with this new innovative solution to treat tremors.
MR-guided focused ultrasound combines two technologies, magnetic resonance imaging , which pinpoints the exact location in the brain responsible for the tremor, and ultrasound, which precisely delivers over 1,000 highly focused beams of acoustic energy at that exact location without damaging any surrounding brain tissue.
Some of the benefits to this technology include: