treating essential tremors with mri-guided ultrasound

What is essential tremor?

Essential tremor (ET) is a brain condition that causes uncontrollable shaky movements of the hands, limbs, head or voice. It is a movement disorder independent of other diseases, and it affects about 3% of people. It is most common in older adults. While it often begins as mild shakiness, it is a permanent condition that usually gets worse. It is more pronounced during movement such as performing tasks with the hands, and less noticeable when at rest. However, if the tremors become dramatic, it can affect a person’s quality of life. Daily activity such as drinking from a glass or cup, shaving, writing or typing, buttoning clothes or tying shoelaces can become difficult–even impossible. For those whose jobs depend on hand coordination, it can interfere with their ability to work. It may be wise to avoid caffeine; stress can also aggravate ET.

How is ET treated?

Depending on the severity of the tremors, treatments range from medication to surgery to a new noninvasive brain procedure using ultrasound.

• Medication is a first-line approach. Drugs called beta-blockers can often control or even remove tremors. Alternatives include anti-seizure drugs or anti-anxiety medicine. Side effects vary, and can include drowsiness, fatigue, or nausea. Beta-blockers can’t be used with some conditions.
• Thalamotomy is a surgical procedure that targets a small area of the brain called the thalamus which controls some involuntary movements, including ET. It is offered when medication is no longer effective. The patient is awake during the procedure. After mapping the area using MRI or CT scans, a narrow hole is drilled in the skull, which is numbed. A very small probe is guided into the thalamus, where it uses radiofrequency or other form of energy to precisely destroy the tremor source. This relieves most, if not all, ET. As with all brain surgery, there are risks including weakness, loss of movement, temporary confusion, temporary balance problems, increased risk of stroke or seizures, and other less common side effects.
• Deep brain stimulation (DBS) involves first implanting a pacemaker-like device under the skin of the upper chest. Then, a narrow hole drilled in the skull allows insertion of an electrode into the thalamus. The electrode is connected by a wire to the implanted device that sends a low level electric current to inactivate the thalamus. Risks and side effects are similar to thalamotomy, with the addition of infection, device complications or failure, and headache.
• Neuravive MRI-guided focused ultrasound (MRgFUS) is a new way of performing thalamotomy that does not require surgical incisions, hole drilling or insertion of probes, when medication no longer works to control ET. The Sperling Medical Group offers the Neuravive procedure using the state-of-the-are Neuravive MRgFUS system. Side effects have been reported (gait disturbances, numbness in the hand or face) but are mostly temporary.

Neuravive at the Sperling Medical Group

The Sperling Medical Group offers a new MRI-guided noninvasive thalamotomy using a breakthrough technology called Neuravive. Thanks to brain mapping done by our powerful magnet and specialized software, Neuravive uses 1024 beams of ultrasound energy all pinpointed on the nucleus of the thalamus that is responsible for the tremor. Each application of focused ultrasound energy is called a sonication. A series of tiny overlapping sonications gradually destroys the targeted area. Since the Neuravive procedure is done inside the MRI “bore” (tunnel), high resolution imaging monitors the treatment. When it is over, the result is an immediate and significant reduction in tremors.

Courtesy of INSIGHTEC developer of Neuravive

What is involved in the Neuravive procedure?

The patient lies on a treatment bed that slides into the MRI scanner. Since no holes are drilled into the skull, no anesthesia is needed. The patient is fully conscious throughout the treatment, which may last up to 3+ hours. The treatment is painless, but a mild sedative may be given to ensure relaxation and comfort.

For ET patients who no longer respond to medication, the Sperling Medical Group is pleased to offer the revolutionary advantages of Neuravive.

Focused ultrasound treatment for essential tremor was approved by the U.S. Food and Drug Administration (FDA) in July, 2016. Only a doctor can evaluate and qualify an ET patient for treatment using the Neuravive MRgFUS.