GHP September 2016

30 | ghp September 2016 Innovation & Technology The next Generation of Essential Tremor Treatment While medication may be used to control the symp- toms, only around 50% of patients have received satisfactory benefits from the drugs currently available. Procedures such as Deep Brain Stimulation (DBS) are available and involve placing electrodes in the brain as well as fitting a pacemaker-like device into the patient’s chest. This requires additional surgeries every few years to replace the batteries powering the pacemaker or to perform other maintenance. While providing a significant reduction of the tremor, many patients are deterred by the level of invasiveness of this treatment option. However for over 30 years, ultrasound waves have been safely used in diagnostic imaging devices and more recently the technology is being harnessed as an alternative to surgery, providing non-invasive therapy for a number of clinical indications in neurosurgery, oncology and gynaecology. MR-guided Focused Ultrasound (MRgFUS) is currently being used to treat neurological conditions such as essential tremor and last month the FDA approved the Exablate Neuro system as the first focused ultrasound device to treat such a condition. MRgFUS uses MRI imaging to plan the treatment, identify the target area and monitor the procedure in real-time whilst ultrasound waves ablate tissue deep within the brain, minimising damage to adjacent healthy tissue – with no incisions. What is MRgFUS and how does it treat essential tremor? By using more than a thousand beams and higher energy levels, ultrasound waves can be focused to generate enough heat to cause thermal ablation, which destroys cells. MRgFUS treatment involves focusing ultrasound waves on a target deep within the brain. The beams pass through the brain tissue and only at the focal point where they converge there is an increase in temperature. For patients with essential tremor the beams converge at the Vim nucleus of the thalamus, the tiny part of the brain that is involved in causing tremors. How does the procedure work? During the MRgFUS procedure, the patient lies down on the treatment bed in the MRI scanner with their head in a helmet which contains transducers that deliver ultrasound beams. The physician identifies and verifies the correct target for treatment and then gradual heats the target tissue. MRI provides contin- uous real-time thermal feedback of the temperature changes at the target tissue, contributing to a high safety profile. Due to its non-invasive nature the Exablate Neuro system carries very minimal risk of infection, bleeding and other surgical complications. It’s performed as a single outpatient procedure and patients experience immediate tremor improvement. Benefits to healthcare professionals Throughout this single outpatient procedure, the patient is awake and able to interact with the treat- ment team, providing the physician with the ability to identify any potential side effects. The treatment takes between 3-4 hours and data from a multi-centre clin- ical study showed that patients generally experience an immediate and significant reduction in their tremor following the completion of the procedure – which is sustained after one year post-procedure. Since there are no incisions, recovery time is rapid with virtually no risk of infection or other complications associated with surgery and patients are able to return to their normal routine within 24-48 hours which reduces the need for hospitalisation. Essential tremor is the most common movement disorder, af- fecting around one million people in the United Kingdom, and millions more worldwide. The most common symptom is hand tremor, but tremors can also affect the head, arms, voice, legs and torso. There is no definitive cure for essential tremor and for most patients the severity of the tremor will increase over time. This can cause patients to experience difficulty performing everyday tasks such as eating, dressing, writing, holding objects and even speaking.