New non-invasive procedure helps stop uncontrollable tremors

Published: Jan. 11, 2018 at 4:26 PM EST
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Harriet Marksfield has had tremors that cause her hands to shake uncontrollably since she was in her 30’s.

“I couldn’t carry a cup, a full cup of coffee, to the table,” said Marksfield.

Dr. Travis Tierney, a neurosurgeon at Sperling Medical Group, said, “Essential tremor is the most common movement disorder, about three times more common than Parkinson’s Disease.”

The condition can be hereditary and, despite medication, gets worse over time.

Now, new technology by Insightec uses MRI guided focused ultrasound to stop the tremors and treat them where they start: the brain.

“It’s focused in the precise spot in the brain where the tremor cells are,” said Dr. Tierney, “And that’s in part of the brain called the thalamus.”

While the patient is in the special MRI, an ultrasound beam targets the specific area of the brain causing the tremor, destroying it.

According to Dr. Dan Sperling, the medical director of Sperling Medical Group, the procedure can “accurately within three to four millimeters destroy a tiny amount of brain tissue that you don’t really need, but that’s causing the side effects of the tremors.”

Patients are awake during the procedure, and they can see it working in real time.

“So we can actually see our results immediately,” said Dr. Sperling, “And the patient sees it, which is very powerful.”

Dr. Tierney said, “You can expect 70 to 80 percent tremor reduction, so in some cases, you may what’s called get tremor arrest, and the tremor’s gone.”

Currently, the procedure is only FDA-approved for treating one side of the brain, so Dr. Tierney only does the dominant hand.



REPORT: MB #4363

BACKGROUND: Essential tremor is a neurological disorder (nervous system) that causes involuntary and rhythmic shaking. It can affect almost any part of the body, but will most often occur in the hands, especially while performing simple tasks such as tying shoelaces or drinking a glass of water. It is not a dangerous condition, but it typically worsens over time and can become severe in some cases. Other conditions do not cause essential tremor, and it is sometimes confused with Parkinson’s disease. Essential tremor usually occurs when a person is using his hands; Parkinson’s-related tremors are most prominent when the hands are at your sides or resting in your lap. Essential tremor does not cause other health problems, and Parkinson’s is associated with stooped posture, slow movement, and shuffling gait. Essential tremor mainly involves the hands, head and voice, while Parkinson’s starts in the hands but can affect your legs, chin and other parts of the body. About half of the essential tremor cases appear as a result of genetic mutation, but the specific gene has yet to be identified. It isn’t clear what causes essential tremor in people without this genetic mutation.


SYMPTOMS AND TREATMENT: Symptoms will begin gradually, usually on one side of the body. Tremors become worse with movement, and usually occur in the hands first, affecting one or both hands. They may include a yes or no motion of the head, and can be aggravated by emotional stress, fatigue, caffeine, or temperature extremes. Patients with significant functional impairment may opt for some form of treatment. Options include non-medical therapy, medication, and sometimes even surgery. Tremors can sometimes be reduced by weighting the limb, usually by applying wrist weights. Non-medical relaxation techniques may also be effective in controlling tremors, since it can be aggravated by stress.


NEW TECHNOLOGY: The company Insightec has created the Exablate Neuro, the first focused ultrasound device approved by the FDA to treat patients with essential tremor. It is a non-invasive, image-guided personalized thalamotomy procedure that treats the tiny part of the brain thought to be responsible for causing tremors, in the Vim nucleus of the thalamus. This treatment is done through an intact skull and doesn’t require any ionizing radiation, incisions or implants. The beams generate enough heat to ablate the targeted tissue during treatment and results are immediate and significant, resulting in reduction of tremor for patients. Currently it is only approved to treat one side of the brain.