Focused ultrasound treatment provides long-term relief for patients with essential tremor

Focused ultrasound treatment provides long-term relief for patients with essential tremor

A high-tech, scalpel-free form of brain surgery developed at UVA Health is providing long-term relief for patients with essential tremor, a common movement disorder, a five-year report shows.

The study provides important insight into the durability of the benefits of focused ultrasound treatment for essential tremor. Five years after treatment, clinical trial participants' treated tremors were reduced by more than 70%, the researchers report. There were no progressive or delayed complications.

It's exciting to see such lasting results after an outpatient procedure for a sometimes disabling problem like ET. It is important to note that most patients had very long-lasting benefits, but there are some cases where tremor may recur.”

Jeff Elias, MD, researcher, UVA Health neurosurgeon and study leader

Focused ultrasound for essential tremor

The focused ultrasound procedure focuses sound waves in the brain to disrupt faulty brain circuits that cause unwanted movements. Unlike traditional brain surgery, no incisions or opening of the skull are required. The minimally invasive procedure is guided by magnetic resonance imaging (MRI), allowing doctors to pinpoint exactly the right location in the brain before treatment.

Initial testing of the procedure at UVA and a small number of other centers often produced dramatic results: Study participants walked into an MRI with their hands shaking uncontrollably and emerged with their ability to write or feed themselves restored.

Although promising, these early tests failed to show how long the procedure's benefits would last. This new study followed clinical trial participants for five years and found that they continued to enjoy significant reductions in their tremors. Other measures of quality of life also improved. No side effects occurred after the procedure was completed.

“This important study confirms the long-term benefits and safety of the focused ultrasound procedure we have performed on hundreds of patients with tremor at UVA,” said Shayan Moosa, MD, a UVA Health neurosurgeon who works with Elias to perform focused ultrasound procedures. “Because it is an incisionless and outpatient treatment, we are able to effectively reduce tremors in patients who may be unable or unwilling to pursue more invasive options.”

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The study described the results of 40 study participants from the original study cohort. It is the largest long-term follow-up study to date of the procedure known as “unilateral thalamotomy.”

The groundbreaking clinical trials at UVA and several other sites paved the way for the Federal Food and Drug Administration (FDA) to approve focused ultrasound for the treatment of essential tremor in 2016. This made the procedure available to patients outside of clinical trials, although there are still a limited number of hospitals that have the advanced technology and expertise to offer this.

The FDA has also approved focused ultrasound for the treatment of tremor and dyskinesia (involuntary movements) of Parkinson's disease based on research at UVA Health and elsewhere. UVA is exploring the technology's potential for a variety of other medical applications, from treating cancer to opening the brain's protective barrier to provide now-impossible treatments for diseases such as Alzheimer's.

Based on its promising research, UVA opened the world's first center for focused ultrasound cancer immunotherapy earlier this year. The center aims to combine focused ultrasound with immunotherapy to improve the immune system's ability to fight cancer.

The new center was created in collaboration with the Charlottesville-based Focused Ultrasound Foundation, a long-time supporter of UVA Health's focused ultrasound research.

Results published

Elias and his colleagues published their five-year follow-up results in the Journal of Neurosurgery. The research team consisted of G. Rees Cosgrove, Nir Lipsman, Andres M. Lozano, Jin Woo Chang, Casey Halpern, Pejman Ghanouni, Howard Eisenberg, Paul Fishman, Takaomi Taira, Michael L. Schwartz, Nathan McDannold, Michael Hayes, Susie Ro, Binit Shah, Ryder Gwinn, Veronica E. Santini, Kullervo Hynynen and Elias. Elias is a consultant for InSightec, the manufacturer of the focused ultrasound device; a full list of author disclosures is included in the paper.

Source:

University of Virginia Health System

Reference:

Rees Cosgrove, G., et al. (2022) Magnetic resonance imaging-guided focused ultrasound thalamotomy for essential tremor: 5-year follow-up results. Journal of Neurosurgery. doi.org/10.3171/2022.6.JNS212483.

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