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MR-Guided Ultrasound In Brain Stops Tremor

March 11, 2011
Written by: , Filed in: Neuroradiology
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MR-guided focused ultrasound will save us from everything!

OK, the Focused Ultrasound Surgery Foundation doesn’t actually make that claim. Quite. But its Web site does say that “focused ultrasound is a revolutionary technology that could help treat diseases that affect virtually everyone.” And that it “could be the ultimate form of noninvasive surgery.”

On February 25, the beginning of a clinical trial funded by the foundation seemed to make a good start in backing those claims. According to the foundation, MR-guided focused ultrasound successfully treated a patient with essential tremor, a common and progressive neurological disorder that causes an involuntary tremor of the arms and often other body parts.

W. Jeffrey Elias, MD, a neurosurgeon at the University of Virginia, and his team directed pulses of focused ultrasound waves through the patient’s scalp and skull to a precisely targeted spot in the thalamus, deep within the brain. The patient received no anesthesia and provided feedback to the medical team during the procedure. He reported that the treatment was painless and walked out of the room afterward.

Dr. Elias reported:

He had been unable to use his dominant right hand for over a decade because it shook uncontrollably. When we completed the treatment, his tremor was gone.

Follow-up assessments will determine whether the tremor will return. But the short-term success appears remarkable. “In the recovery room,” Dr. Elias said, “he used his right hand to drink from a cup without spilling, and he even worked on a crossword puzzle.”

The clinical trial will continue, under an FDA-approved protocol, for as many as 15 patients. Dr. Elias noted that it is only the first step in a lengthy process. “We need to complete this study and other clinical trials successfully before this treatment is eligible for approval by the FDA and its counterparts in other countries,” he said.

The news is not so encouraging regarding the use of high-intensity focused ultrasound (HIFU) to treat prostate cancer. A new study, published in the March issue of The Journal of Urology, looked at 15 men whose HIFU treatment had failed, leading to radical prostatectomy.

It found that the pathology results were “alarming” and that morbidity was higher after salvage prostatectomy than after primary surgery.

Declan G. Murphy, MB, BCh, BAO, of the department of urological oncology at the Peter MacCallum Cancer Centre in Melbourne, Australia, wrote an accompanying editorial comment. “Whether it is that standard prostate biopsy cannot be relied on to predict final pathological outcome, or that HIFU ‘makes cancer angry,'” he wrote, “patients should be fully counseled about what we know and, importantly, what we do not know about HIFU treatment for localized prostate cancer today.”

Nathan Lawrentschuk, MBBS, PhD, of the department of surgical oncology at Princess Margaret Hospital in Toronto, was lead author of the study. He told Medscape Medical News: “I do not advise patients to have HIFU. There may be a problem with HIFU selecting out more aggressive cells, but this warrants further study.”

Related seminar: Neuroradiology Review

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