First UK essential tremor patients treated with focused ultrasound

Doctors at Imperial College Healthcare NHS Trust perform non-invasive MR-guided Focused Ultrasound thalamic lesioning on patients with essential tremor

  • Essential tremor is most-common movement disorder, affecting one million people in the UK
  • Current treatments include Deep Brain Stimulation (DBS) and thalamotomy
  • New trial at Imperial College Healthcare NHS Trust exploring impact of non-invasive MR-guided Focused Ultrasound thalamic lesioning treatment
  • Treatment involves applying low-energy ultrasound waves under magnetic resonance imaging to identify the part of the brain that causes the tremors, then using high-intensity ultrasound waves to destroy target tissue
  • Early results show tremors stopped or were reduced significantly

The treatment has been found to significantly reduce, or in some cases stop, tremors

Imperial College Healthcare NHS Trust has performed the first focused ultrasound treatment in the UK for essential tremor.

Essential tremor is the most-common movement disorder, affecting around one million people in the UK alone, and millions more worldwide.

The most-common symptom is hand tremor, but tremors can also affect the head, arms, voice, legs and torso.

Patients often experience difficulty performing everyday tasks such as eating, dressing, writing, holding objects and even speaking.

Patients who fail to respond to medication may be treated with surgical procedures such as Deep Brain Stimulation (DBS) or thalamotomy.

Now, a medical team at Imperial College Healthcare NHS Trust led by neurosurgeon, Dipankar Nandi; radiologist, Professor Wladyslav Gedroyc; and neurologist, Dr Peter Bain, are performing non-invasive MR-guided Focused Ultrasound (MRgFUS) thalamic lesioning for treating essential tremor using the Exablate Neuro as part of a trial.

Selwyn Lucas is one of the first patients to be treated in the UK

The treatment starts with applying low-energy ultrasound waves under magnetic resonance imaging (MRI) to identify the small part (3 mm X 3mm X 5 mm) of the brain that is thought to be responsible for causing tremors, part of the thalamus and sub –thalamic region. Once located, high-intensity ultrasound waves are applied to heat and destroy only the target tissue. The whole procedure is performed while the patient is fully conscious and lying on the treatment bed in an MRI scanner.

The result for certain patients is an immediate and significant reduction of their tremor.

Non-invasive focused ultrasound treatment minimises risk of infection, and the risks of bleeding, stroke or other surgical complications and allows patients to return home usually the same day.

Nandi said: “I have been performing DBS operations for over 15 years. This breakthrough allows us now to operate on these patients without the significant risks that inserting an electrode 15 cms deep into the brain entails.

“We are at the cusp of widening the applications of this innovative technology to help a wide variety of patients, some of whom had no therapeutic option before.”

The technology is made by INSIGHTEC. Its vice president of neurosurgery, Rick Schallhorn, said: “Patients with essential tremor now have a treatment option that allows them to be treated on an outpatient basis and quickly return to their daily life with improvement in their tremor.”

Selwyn Lucas, a 52-year old painter and decorator from St Austell in Cornwall, is one of the first people to receive the treatment as part of the trial in the UK. He has lived with a tremor in his right hand for more than 20 years, which has grown progressively worse over the last five years.

Commenting on the treatment, he said: “For many years I managed to live a relatively-normal life with my tremor, but over the last five years it had started to prevent me from leading the life I wanted to lead. It was also particularly difficult to continue my job as a painter and decorator as I had to learn to perform my job using my left hand and being a right-handed person this slowed my ability to complete jobs.

“Since the treatment I have been able to write my own name for the first time in many years and taken my wife out for a lovely meal without fear of embarrassing myself. I will also be able to go back to using my right hand which will allow me to take on more painting and decorating jobs.”