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

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A form of high-tech, no-scalpel brain surgery pioneered at UVA Health offers long-term relief for patients with essential tremor, a common movement disorder, a five-year review shows.

The study offers important information about the durability of the benefits of focused ultrasound treatment for essential tremor. Five years after treatment, clinical trial participants continued to have their treated tremors reduced by more than 70%, the researchers report. There were no progressive or late complications.

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

Jeff Elias, MD, Investigator, Neurosurgeon at UVA Health and Principal Investigator of the study

Focused ultrasound for essential tremor

The focused ultrasound procedure focuses sound waves within the brain to disrupt faulty brain circuits that cause unwanted movement. Unlike traditional brain surgery, it does not require incisions or opening of the skull. The minimally invasive procedure is guided by magnetic resonance imaging (MRI), so doctors can pinpoint the exact spot in the brain before administering treatment.

Initial tests of the procedure at UVA and a small number of other sites often produced dramatic results: Study participants entered an MRI with their hand shaking uncontrollably, and emerged with their ability to write or feed themselves restored.

While promising, those early tests failed to reveal how long the benefits of the procedure would last. This new study followed clinical trial participants for five years and found that they continued to enjoy a significant reduction in their tremor. Other measures of quality of life also improved. Side effects did not occur after the procedure was completed.

“This important trial verifies the long-term benefits and safety of the focused ultrasound procedure we have performed for hundreds of tremor patients at UVA,” said Shayan Moosa, MD, a UVA Health neurosurgeon who partnered with Elias to perform focused ultrasound. “Because this is an outpatient treatment and no incisions, we can effectively reduce tremor in patients who are unable or unwilling to pursue more invasive options.”

The study described the results of 40 trial participants from the original study cohort. It represents the largest long-term follow-up study of the procedure, known as “unilateral thalamotomy,” that has been performed to date.

Pioneering clinical trials at UVA and a handful of other sites paved the way for the federal Food and Drug Administration to approve focused ultrasound for the treatment of essential tremor in 2016. That made the procedure available to patients outside of the trials. clinics, although there are still a limited number of hospitals with the advanced technology and experience to offer it.

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

Based on its highly promising research, UVA launched the first focused ultrasound cancer immunotherapy center 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 opened in conjunction with the Charlottesville-based Focused Ultrasound Foundation, which has long supported UVA Health’s focused ultrasound research.

published findings

Elias and his collaborators have 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 authors’ disclosures is included in the document.

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University of Virginia Health System

Magazine 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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