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Ultrasound Procedure Reduces Tremors in Parkinson’s Disease, Essential Tremor Disorder

Researchers report a new ultrasound treatment reduces tremors in people with Parkinson’s disease and essential tremor disorder.
They add the procedure eliminates the risks associated with surgery and produces shorter hospital stays.
The availability of the treatment is limited. About 50 centers around the world perform the procedure, including 16 in the United States.

Researchers are unveiling a new way to treat tremors in people with Parkinson’s disease, a therapy involving ultrasound treatment instead of traditional methods of surgery.

The treatment will be officially presented at the annual meeting of the Radiological Society of North America in Chicago.

The method involves focused beams of sound energy used to heat and destroy a small part of a structure in the brain called the thalamus.

The technology used is magnetic resonance–guided ultrasound (MRgFUS).

It provides relief to the opposite side of the body, meaning treatment to the right side of the brain would, for example, help symptoms on the left side of the body, and vice versa.

“As far as one side of the body, it’s the treatment to beat as far as I’m concerned,” Casey H. Halpern, MD, a neurosurgeon with Stanford Health Care in California who has researched and used the ultrasound treatment, told Healthline. “Especially for half the body tremor. It’s risk versus reward. The improvements are tremendous.”
Advantages to ultrasound

Doctors have traditionally treated people with Parkinson’s disease and essential tremor disorder by surgically attaching a small electrode in the brain connected to a pulse generator implanted in the chest like a pacemaker.

There are many advantages to using ultrasound.

Ultrasound eliminates the inherent risks of surgery, which include possible infection, bleeding, and elevated risk of stroke.

The length of hospital stay is shorter. The treatment is “a fairly well-tolerated procedure even by the more fragile patients,” said Federico Bruno, the study’s lead author and a radiologist in the department of biotechnological and applied clinical sciences at the University of L’Aquila in Italy, in a statement.
Results of the research

Bruno’s team studied 39 people with an average age of 64 years.

All the study participants had disabling tremors for at least 10 years that didn’t respond to treatment.

Eighteen of the participants had essential tremor disorder while 21 participants had Parkinson’s disease.

Researchers reported that 37 of the 39 participants experienced substantial and immediate reduction of their tremors.

A follow-up evaluation over the ensuing year showed substantial improvement in both groups.

“It is a single session treatment, usually performed on an outpatient basis,” said Maurice R. Ferre, MD, chairman and CEO of INSIGHTEC, the creator of the ultrasound device used in the study. “There are very few celebratory moments in a hospital setting. This is one of them.”

The benefits, Ferre told Healthline, are numerous.

“Immediately after focused ultrasound treatment, many essential tremor patients are able to sign their name for the first time in years,” he said. “Participants in our clinical study demonstrated a 76.5 percent improvement in tremor severity at 3-year follow-up, and 74 percent of adverse effects reported were mild and the rest were moderate.”

Halpern says ultrasound helps doctors as well, as far as seeing results quickly.

“Focused ultrasound can produce immediate effects,” he said. “Response is immediate, and you can ensure the response is effective.”
Reaction to the research

Sandeep Thakkar, DO, heads the Parkinson’s 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, it’s short term,” Thakkar told Healthline.

Jean-Philippe Langevin, MD, a neurosurgeon at Providence Saint John’s 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 don’t work very well,” Langevin told Healthline.

“There’s a number of patients who don’t want the (surgery). It could be they’re 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. “It’s not the entire thalamus (being eliminated). It’s just a tiny portion.”
Availability limited for now

Doctors say the procedure will initially be expensive, as availability will be limited.

“Right now, it’s not easily accessible because word isn’t really out,” Thakkar said, listing Stanford and UCLA as two locations already doing the procedure.

Ferre says there are about 50 centers around the world using focused ultrasound on people with tremor from essential tremor and Parkinson’s, including 16 in the United States.

“It’s an important therapy, and it’s important for hospitals to get this,” Halpern said. “It’s expensive, but this problem is extremely common. It effects so many people. We need hospitals to know about this because it’s a great investment. It’s not just something that should be done at a few specialty facilities.”