University of Maryland Medicine offers MRI-guided focused ultrasound treatment to Par
 

University of Maryland Medicine offers MRI-guided focused ultrasound treatment to Parkinson's patients

http://www.news-medical.net/news/201...-patients.aspx

improvement?
 

I sure wish they had included something about whether the patient improved or not-this is something, given the nature of the procedure, that I think would show benefits pretty quickly if it were going to be beneficial.

Other PWP have received this same treatment around the world, but how are they doing?

http://www.nbcwashington.com/video/#...ason/324002491

Looks like this may be the first women who's had it done. I almost started to cry when she was running!

thanks for that link. pretty amazing results in that one patient. lots of questions of course but also happy to hear ET patients have had positive outcome last for a year. i assume this replaces pallidotomy, thalamotomy, old surgical procedures and an alternative to DBS.

I assume a lot cheaper than DBS for obvious reasons.

I have seen examples where Dr. Lozano has used focused ultrasound beams to treat patients with severe Essential Tremor. The results are amazing and immediate.

Here is a link to a youtube video showing a patient with Essential Tremor before and after this type of surgery.

https://www.youtube.com/watch?v=fdF_3eqp1pk

It is more like pallidotomy than DBS.

oops - here's the correct link
 

Using ultrasound to destroy a small portion of brain tissue seems to help PD patients in the short term. I'm not sure if this continues to help long term though.

Treatment Site Commercial Treatment Clinical Trial Location Country
Sunnybrook Health Sciences Centre ✓ Toronto, ON Canada
Rambam Medical Center ✓ Haifa Israel
ResoFus - Centre Medic Alomar ✓ Barcelona Spain
Center for Ultrasound Functional Neurosurgery ✓ Solothurn Switzerland
FUS-Center, University of Zurich, Children's Hospital ✓ Zurich Switzerland
Swedish Neurosciences Institute ✓ Seattle, WA United States
University of Maryland School of Medicine ✓ Baltimore, MD United States
University of Virginia (UVA) Health System ✓ Charlottesville, VA United States

As soccertese stated above, the results with ET have been very good so far, and have lasted the year since the trials started.

questions
 

1. is this primarily for tremor-dominant PWP?
2. does having this preclude you from other clinical trials down the road like DBS does?
3. what effect does this have on balance, rigidity, mood, sleep, constipation (what am I missing here?)...
4. what are the outcomes of the patient in Canada that had this done and the 7-8 patients in Korea that had this done? That would be very helpful to know!

If anyone knows, please post/share!

lurking, sounds like they are treating patients that meet the same criteria as DBS but the person in the video sure had severe dyskinesias so maybe that is a requirement, best thing to do is contact the institution. i've read that pallidotomy(?) is widely used in CUBA where DBS is too expensive.


http://neurosurgery.mgh.harvard.edu/...al/pallidt.htm
PALLIDOTOMY

Indications for Pallidotomy

Only patients with treatment-resistant idiopathic Parkinson's disease that have clearly responded to dopamine replacement therapy in the past should be considered candidates for pallidotomy. While many of the cardinal symptoms of PD will respond to pallidotomy, the features of the disease which respond best are drug induced dyskinesias, painful dystonias, marked ON/OFF fluctuations, severe bradykinesia, and rigidity. Symptoms that may improve but do so less reliably are tremor, speech dysfunction and gait disturbance. Postural instabilitiy is rarely if ever helped. The ideal patient is young (< 50 years of age), suffers from asymmetric idiopathic PD and has severe ON/OFF fluctuations with drug induced dyskinesias. Hemidystonia is another indication for pallidotomy which appears to hold promise although the available data is limited.

http://www.fusfoundation.org/disease...nsonian-tremor

Compared to implantation of a deep brain stimulation device, focused ultrasound is a single procedure, and does not require subsequent procedures to replace batteries. It also does not involve the collateral damage to healthy tissue or the risk of blood clots and infections associated with implanting a foreign body.

http://www.parkinson.org/sites/defau...on_Therapy.pdf
Parkinson’s Disease
:
Guide to Deep Brain
Stimulation Therapy

Unlike DBS, pallidotomy should not be performed on both sides of the
brain, and this is one major limitation of this surgery. Performing two pallidotomies can
lead to permanent speech, swallowing, and cognitive problems. Patients with an existing
pallidotomy who require a second surgery will usually have a DBS placed on the opposite side of the brain.

------
i think this ultrasound procedure can only be done on 1 side.

confusing...
 

Towards the end he says that where the ultrasound beams converge, they heat up the "abnormal cells" and kill them---when did cells become abnormal? How can they tell which cells are abnormal and which ones are not?

I have never read anything about PD that said any cells were "abnormal", only that a protein (a-syn) could misfold and cause clumps (which they find on autopsy)...does anyone know anything about this or did the man mis-speak?

I don't think he was referring to "abnormal" cells like one would with cancer cells. PD brain cells, though, are abnormal in several ways. They can develop Lewy bodies from the clumped a-syn, they lose their nerve endings that produce norepinephrine, and they develop mitochondrial dysfunction. This all takes place prior to the actual premature death of the cell. Maybe he was alluding to killing these cells while they are still alive, but dysfunctional. Just a guess.

I believe he mis-spoke.

Have to disagree with you on this. The Exblate ultrasound works by sending high intensity waves to non-invasively heat and destroy tissue. The procedure for PD is a subthalatomy, which is a lesioning of the subthalmic nucleus. Specifically, the procedure destroys the subthalmic nucleus (which is part of the basil ganglia and next to the substantia nigra). The purpose of this procedure is to destroy cells. Are the cells abnormal? Call it what you like, but they are definitely not normal brain cells anymore. If they were, we wouldn't have PD.

and yet another theory...
 

I thought the purpose of this procedure was to sever a connection (ie, interrupt a circuit) in the brain, which is accomplished by destroying some cells...not necessarily target the STN for destruction. Now, are those cells in the STN abnormal? I didn't think so, and have never heard of this before.
And saying those cells in the STN must be abnormal or we wouldn't have PD is assuming they are the cause of PD, and I have never heard of that before, either. If that's true, why doesn't this procedure work for all PWP and abolish all symptoms?

I can't forget Dr. Jannetta's theory that PD is caused by a cerebral artery impinging on nerves in the brain and irritating them...he treated that lady for trigeminal neuralgia (who also had well documented PD going back 8 or 9 years, I think it was) and upon awakening, discovered that not only was her trigeminal neuralgia relieved by the Teflon pad placed under the cerebral artery in her brain, but her PD was gone. Her PD symptoms returned months later and on MRI they discovered the Teflon pad had slipped, so they had to go back in and secure it...and PD symptoms abated again. Seems pretty convincing of a cause and effect to me, at least for that patient. I've not been able to find out any more about that patient or Dr. Jannetta, though I have tried.

If they are actually targeting the STN for destruction, that seems a much more radical (and scary!) procedure than just severing a nerve connection in the brain (which is still scary!!).

[QUOTE=lurkingforacure;1168721]I thought the purpose of this procedure was to sever a connection (ie, interrupt a circuit) in the brain, which is accomplished by destroying some cells...not necessarily target the STN for destruction. Now, are those cells in the STN abnormal? I didn't think so, and have never heard of this before.
And saying those cells in the STN must be abnormal or we wouldn't have PD is assuming they are the cause of PD, and I have never heard of that before, either. If that's true, why doesn't this procedure work for all PWP and abolish all symptoms?

QUOTE]

Lurking, this has become a very interesting discussion and probably time for us to get some direct feedback from the manufacturer and researchers. I'm going to send them emails for comment.

Regarding my comments, I never said the target was the Substantial Nigra. I said it was a subthalatomy targeting the subthalmic nucleus ,which is another part of the basil ganglia and next to the substantia nigra. However, I was incorrect in that regard as the video was from the Maryland U study, not the larger ongoing Virginia U study. The Maryland study (also being conducted at the U of Va) is targeting the Globus Pallidum, which is also a component of the basil ganglia near the substantia nigra.

In both studies, the procedure destroys tissue in the targeted area. That is a fact as reported by both the manufacturer, Insightec, and the research teams at both universities. So, I guess, back to your initial question, are the cells being destroyed "normal" functioning brain cells or "abnormal" in some way? That is the question I've asked the them in my email.

I will update with any responses I receive.

[QUOTE=lurkingforacure;1168347]1. is this primarily for tremor-dominant PWP?

I believe they are testing on people with tremor dominant PD.

This info was provided on one of the webs link that Soccertese posted:
http://www.fusfoundation.org/disease...nsonian-tremor


Focused ultrasound is being studied to treat two symptoms of Parkinson’s through lesioning of one of two target areas of the brain:

Parkinsonian tremor – lesioning target in the thalamus (thalatomy)
Parkinsonian dyskinesia – lesioning target in the globus pallidus (pallidotomy) or subthalamic nucleus
At this time, focused ultrasound is only being assessed to treat one side of the brain, so it will affect tremor or dyskinesia unilaterally.

Thalatomy trial wraps up this October after 3 years. Sure would be nice to see some results from this.

Here is a link to one report published last year


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4178774/

Ask Michael J. Fox
 

He had a thalamotomy done years ago, before revealing he had Parkinson's.

I doubt the FDA will be quick to approve permanent zapping of brain cells, but who knows?

Addendum:
After reading the article (link posted above by dilmar - ALL 25 pages!) there are several considerations to be taken with MRI focused ultrasound therapy. The work done in this area ( as noted in the article) dates back to 1959! I was a little shocked by this fact. So we definitely can't call this "new" work. And it works best on tremor-dominant people.

The key to any of these invasive procedures ( and focused ultrasound is invasive, also), is to find a very precise location deep in the brain's structures. The lazar can heat up surrounding skull bones and cause permanent damage, and with DBS, the exact location to the tiniest spot must be carefully found, possibly resulting in a brain bleed or stroke.

Read everything you can, talk to those who have had the surgery, pray, and keep your fingers crossed if considering this type therapy.