What's Shaking

The Lowdown on Focused Ultrasound Thalamotomy — A treatment for Essential Tremor

While there is no cure for essential tremor, a neurological disorder that causes uncontrollable rhythmic shaking or tremors, there are several treatment options for those struggling with the condition. Treatment options range from lifestyle changes and medication (such as beta blockers) to more serious options such as surgery. Surgery is typically reserved for patients dealing with very severe tremors that aren’t responding to medication or other interventions.

What is focused ultrasound thalamotomy?

A relatively new noninvasive surgery called focused ultrasound thalamotomy involves using focused sound waves that travel through the skull and skin. The FDA approved treatment uses sound waves to destroy brain tissue as a way to stop a tremor and employs the same type of ultrasound waves people are familiar with when looking at their unborn babies inside the womb.

According to the Mayo Clinic, “The waves generate heat to destroy brain tissue in a specific area of the thalamus to stop a tremor. A surgeon uses magnetic resonance imaging to target the correct area of the brain to be sure the sound waves are generating the exact amount of heat needed for the procedure.”

The International Essential Tremor Foundation characterizes the focusing of these waves as similar to the way that a magnifying glass, when focusing beams of sunlight at an object, is able to burn a hole in a leaf for example.

The Procedure

Patients will have their heads shaved and wear a stereotactic frame (a head instrument that provides reference points for targeting that sort of looks like a protractor) and are moved into an MRI machine where they remain for the duration of the procedure. Transducers from the frame deliver ultrasound waves to the brain, traveling through the skin, skull, and brain until they converge and target the brain tissue.

“The destruction of the target tissue interrupts circuits of the brain responsible for tremor,” the IETF explained. “Patients are fully awake during the procedure, interacting with the medical team as they assess progress in reducing tremor throughout the process. And although the process takes several hours, the benefits can be felt immediately. There is virtually no downtime and patients are usually able to go home the same day. Most return to activities of normal life within 24 hours.”

What are the risks of focused ultrasound thalamotomy?

The Mayo Clinic warns that focused ultrasound thalamotomy, although noninvasive, creates a lesion that can result in permanent changes to brain function and noted that “some people have experienced altered sensation, trouble with walking or difficulty with movement. However, most complications go away on their own or are mild enough that they don’t interfere with quality of life.”

The IETF reported that 74 neurological adverse events were reported in 56 of the 74 essential tremor patients who received focused ultrasound thalamotomy treatment in an initial study. The most common side effect was altered sensation that persisted for 12 months for 14% of the original 38% of patients who reported it. Gait disturbance, coordination issues, and issues with balance and walking were also reported.

Benefits of Focused Ultrasound Thalamotomy

A Neuravive clinical study reported that tremor severity improved 76.5% over baseline at a three-year follow-up for its focused ultrasound thalamotomy patients. Improvement in tremor and motor function was at 53% at three years and functional disability showed a 56.9% improvement from baseline at three years.

While the procedure is relatively new and its risks and effectiveness are still being surveyed, many essential tremor patients struggling with severe tremors have found focused ultrasound thalamotomy to be a solution that improves outcomes.

If you are dealing with the symptomatic uncontrollable rhythmic shaking of essential tremor, consider talking to your doctor about your surgical options.

While Essential Tremor Products cannot and does not endorse one treatment option over another and does not claim to be a medical expert, we do aim to be a resource for information and news that is pertinent to the essential tremor community.