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“If not, we would continue prescribing medications, as those side effects can be more manageable than complications from a surgical procedure.”īefore undergoing focused ultrasound, patients are evaluated by neurologists, who assess the patient’s general physical condition, risk factors for bleeding, adverse reactions to MRI, and other intracranial or cognitive impairments. “For the expected benefits to outweigh the risks, the signs and symptoms of disease must be severe enough to affect the patient’s quality of life,” explains Binit Shah, MD, assistant professor of neurology in the Parkinson’s disease and movement disorders division at the University of Virginia in Charlottesville. If pharmaceuticals are not effective, patients are usually referred to a surgical movement disorders team for DBS and, increasingly, focused ultrasound. In most cases, essential tremor is managed first with medication, including beta blockers, anti-seizure or anti-anxiety medications.

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The amount of stimulation is controlled by a battery-operated pacemaker-like device placed under the skin in the upper chest. The surgery involves drilling a small hole in the skull and implanting electrodes in the brain, which deliver electrical stimulation to the thalamus or the globus pallidus, another area related to Parkinson's symptoms, to stop the tremors.

In 1997, deep brain stimulation (DBS) was approved to treat essential tremor and the tremors of Parkinson’s disease. Less than 40 years ago, the only surgical treatment for essential tremor required inserting a probe in the skull to either freeze or coagulate the thalamus, the relay station for motor and sensory signals and a key area implicated in tremor symptoms. In a 2017 study, published in the Journal of Neurosurgery, of 30 patients (18 of whom had essential tremor, nine with Parkinson’s, and three with essential tremor-PD), all showed significant improvement in their tremor up to six months after treatment. In a 2019 study, published in Movement Disorders, 62 percent of patients showed improvements in their Parkinson’s-related tremor compared with a group that had a sham treatment. “Instead of using an optical lens to focus beams of light, focused ultrasound uses an acoustic lens to focus multiple beams of ultrasound energy on a specific target.”Įmerging research supports the benefits of focused ultrasound. “The fundamental principle is analogous to using a magnifying glass to focus beams of sunlight on a single point to burn a hole in a leaf,” says Neal Kassell, MD, professor of neurosurgery at University of Virginia and chairman of the Focused Ultrasound Foundation, a nonprofit organization created to accelerate the development and adoption of focused ultrasound as a treatment. Surgeons use MRI scans to locate the target, and after guiding the laser to the specific area, they send more than 1,000 beams of sound waves to burn and destroy it. When once she was too ashamed to talk about her tremors, Lebenthal now tells anyone who will listen about it, often demonstrating how steady her left hand is compared with her still-shaky right hand.įocused ultrasound-approved by the US Food and Drug Administration for essential tremor in 2016 and for tremors in Parkinson’s disease (PD) in 2018-relies on two types of technology: MRI and sound waves. “And using my smartphone was a disaster.” After the procedure, she could type and text on her phone and even take a video. “Before the procedure, I had to hold a cup of coffee with two hands,” she says.

Those feelings changed in 2017 when Lebenthal underwent a then-experimental therapeutic procedure called focused ultrasound-a minimally invasive method of targeting and zapping the area of the brain responsible for tremors-to reduce or eliminate the tremor in her left hand, which is her dominant hand.įor Lebenthal, a high-powered financial executive, the treatment was life-altering.

Although the tremor in both hands didn’t keep her from doing anything she wanted to do, it was embarrassing and made her feel ashamed and self-conscious-and she never talked about it. This neurologic condition is characterized by involuntary shaking of the hands, and sometimes of the head, voice, or other body parts. A look at the minimally invasive treatment used to reduce or eliminate tremors.Īlexandra Lebenthal, 55, has had essential tremor since she was a child but wasn’t officially diagnosed until her early forties.

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