Transcranial image-guided focused ultrasound was capable of targeting and ablating areas of the brain involved with tremors, and brought relief to individuals with Parkinson’s disease or essential tremor, researchers reported here.
In a study involving 39 patients with tremor, substantial improvement was reported in 37 individuals, and that improvement continued over the course of at least one year, said Federico Bruno, MD, of the University of L’Aquila in Italy, at the Radiological Society of North America’s annual meeting.
Bruno told MedPage Today, “We have continued to perform these treatments on patients since we submitted our abstract and now have treated more than 60 people. This is a second-line therapy, that differs greatly from deep brain stimulation. There is no brain incision or wire placement with magnetic resonance-guided focused ultrasound thalamotomy.”
After medical therapy fails or stops working, treatment options have included deep brain stimulation and laparoscopic or even open surgery to ablate tissues where tremors are thought to arise.
As a non-invasive approach, focused ultrasound has advantages over deep brain stimulation, including minimal risk of complications from bleeding and infections, Bruno said. “Another advantage is the immediate effect this treatment provides, unlike deep brain stimulation which requires a break-in period for the electrostimulation,” he said. “Additionally, treatment with magnetic resonance-guided focused ultrasound requires shorter hospitalization and is a fairly well-tolerated procedure even by more fragile patients.”
Michael Lev, MD, director of emergency radiology and professor of radiology at Massachusetts General Hospital/Harvard Medical School, Boston, told MedPage Today, “Focused ultrasound has been used in multiple medical fields, from cancer to tremors, and its extension here is to Parkinson’s disease. That is the new twist.”
“A problem with deep brain stimulation, aside from it requiring surgery, is that the wires and electrodes may make future imaging difficult because they case imaging artifacts.” He called it a “nice idea” to use a non-invasive method, with which radiologists are already somewhat familiar, and that avoids the artifact problem.
However, Lev cautioned, “These are always works in progress. You do a small series, you check for safety, but considering there is a track record with this treatment, I think this is promising.”
For the new study, Bruno and colleagues enrolled patients, average age 64.5, with disabling tremors that had not responded to standard treatment. The 39 patients included 22 men and 17 women enrolled from February to March 2018. Eighteen were diagnosed with essential tremor and 21 with Parkinson’s disease. They had experienced symptoms for an average of more than 10 years.
Temporary side effects and complications occurred in seven patients after treatment, with resolution at the 6-months follow-up in four patients. Instrumental imaging follow-up showed a progressive reduction of thalamotomy lesion size and perilesional edema in both groups.
Patients were evaluated using the Fahn-Tolosa-Marin (FTM) scale for tremor and the QUEST score for quality of life at baseline and then at 1-month, 6 months, and 1 year. In patients with essential tremor, FTM scores dropped from a mean of 36.2 at baseline to 13.8 immediately after treatment. At one month the mean score was 14.6; it was 14.3 at 6 months and 14.5 among patients evaluated at 1 year.
Among the Parkinson’s disease patients, FTM scores decreased from mean values of 27.5 before treatment to 11.6 immediately after treatment. At the 6-months follow up, mean FTM score was 15.5, due to mild recurrence of tremor in four patients, that remained stable at 1 year.
In the QUEST quality of life evaluation, Bruno said mean scores in essential tremor patients fell 73.2% and by 68% among the Parkinson’s disease patients.
“The study we present reports our experience of over a year in the treatment of tremor by thalamotomy with focused ultrasound,” Bruno said. “It is worth noting that we had a high number of patients with Parkinson’s disease in our series, compared to previously published data, where the procedure was used mainly in the treatment of essential tremor patients.”
Bruno disclosed no relevant relationships with industry.
Lev disclosed relevant relationships with GE and Takeda.
Primary Source
Radiological Society of North America
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