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Using MR guided focused ultrasound to treat essential tremors

by John W. Mitchell, Senior Correspondent | October 28, 2015
MRI Population Health Ultrasound
Steven Palovchik
Courtesy Ohio State University
Wexner Medical Center
A new protocol in trial at six health systems nationwide is showing very promising results in treating essential tremors, which affect roughly 10 million people in the U.S. The clinical trials for MRI Guided Focus Ultrasound (MRGFU) have treated about 80 patients so far.

“I confess I was not a believer at first,” Dr. Vibhor Krishna, a neurosurgeon at Ohio University Wexner Medical Center, one of the medical centers where clinical trials are being held, told HCB News. He first performed these operations during his fellowship training in Toronto.

“This new procedure is a life changing experience for patients. It is a powerful experience to see these patients - who experience difficulty with simple tasks such as button a shirt, tie shoes or write their name - dramatically improve without drilling a hole in their skull,” Krishna said, contrasting it with the current approved deep brain stimulation treatment.
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Besides experiencing difficulty with activities of daily living, patients with essential tremors are also prone to accidents which sometimes compromise their independent living. Such rhythmic tremors are progressive, causing trembling in the hands, head, legs, trunk and speech. The new MRGFU procedure is currently intended for patients who cannot control tremors with medication.

A specially trained team performs the procedure in the MRI room while the patient is conscious. MRGFU directs a concentrated ultrasound wave composed of over 1,000 ultrasound pulses to a spot in the thalamus area of the brain. This ablates the specific cells and hyperactive pathways that cause the tremors.

The procedure destroys the targeted cells by raising the surrounding ambient temperature by about 50-60 degrees centigrade. During the procedure the patient is protected from surrounding tissue burns with a specially designed water-cooled helmet.

Steven Palovchik, 71, who suffered from tremors since he was a teenager called the procedure “a gift from heaven.” In a video interview he held up a right hand that he called “rock solid”, the tremors gone after his treatment.

“Frankly, sometimes we don’t know why people develop tremors,” said Krishna, adding that the MRGFU treatment takes advantage of a basic truth about the brain. “There is some healing that happens, but complete rewiring or regeneration of the brain is not possible. So we take advantage of that.”

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