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Study researches noninvasive treatment option for essential tremor

For people with the disorder essential tremor, simple tasks such as drinking water, writing or using utensils, can be the most difficult ones. Although the exact cause of the involuntary movements associated with the condition are unknown, thalamotomy, or the purposeful erosion of a section of the brain, has proven successful in the past as a treatment. The invasive brain surgery isn’t for everyone, however, which is why a team of scientists led by principal investigator and Neurology Prof. Dr. Jeff Elias has come up with a form of thalamotomy using magnetic-resonance guided focused ultrasound.

The study, published in August by the New England Journal of Medicine, reports positive results from 15 patients with essential tremor treated with this new noninvasive procedure. Dr. Max Wintermark, associate professor of Radiology, Neurology, Neurosurgery and Biomedical Engineering and the chief of Neuroradiology at the University, said the other treatment options include medication or invasive modalities such as radiofrequency ablation, where electrodes are placed on the patient’s brain, or gammaknife ablation, which involves using gamma radiation.

MRI-guided focused ultrasound is a noninvasive alternative option, which uses ultrasound to heat up a very small region of the brain, carefully selected using magnetic resonance imaging,” Wintermark said in an email. “The lesioning of this small region of the brain interrupts the neuronal circuit that causes the tremor.”

The preliminary results are very promising, Wintermark said. Results were gauged by the Clinical Rating Scale for Tremor, showing a 48 percent improvement in hand tremors, 49 percent improvement in the the disability subscore, 19 percent improvement in overall tremors and a 26 percent decrease in average score on the Quality of Life in Essential Tremor Questionnaire, where higher scores indicate a greater perceived disability.

Essential tremors can be extremely debilitating, Wintermark said, and some patients will withdraw into their homes and isolate themselves from social situations because of the stigma surrounding their symptoms.

“The most fulfilling aspect of this research is to have witnessed patients with essential tremor being significantly improved by this new treatment modality,” Wintermark said. “After the treatment, the patients were finally able to drink without spilling water from their glass, they were finally able to eat from their plate and sign their name.”

Although the results are impressive, there is more work to be done. Elias is also conducting an initial clinical trial testing the new method on patients with Parkinson’s disease that has proved resistant to medication.