A new type of brain surgery, called focused ultrasound, is being tested in clinical trials worldwide. Unlike traditional brain surgery, it does not require incisions or cause bleeding. The procedure uses sound waves to target specific brain parts, disrupting the malfunctioning circuits that cause symptoms such as essential tremors and depression. Dr. Neal Kassell, the founder and chairman of the Focused Ultrasound Foundation, explains that it is a non-invasive and powerful technology that can potentially save lives. He compares it to using a magnifying glass to focus light beams on a point and burn a hole in a leaf, following a CNN report.
Dr. Kassell added that focused ultrasound uses an acoustic lens to focus multiple beams of ultrasound energy on targets deep in the body with high precision and accuracy without damaging the surrounding normal tissue. This technology has proven to be particularly beneficial for people with essential tremors. This neurological disorder causes involuntary and rhythmic shaking, which can affect almost any body part but is most commonly found in hands. This disorder can worsen with movement and is most common in people 40 and older, affecting nearly 25 million worldwide, according to a 2021 study.
Brenda Hric, 80, recently underwent focused ultrasound at the University of Virginia and experienced significant improvement. Her tremors had made her feel uncomfortable in social situations, as she was afraid of spilling or knocking something over. However, just 44 seconds of focused ultrasound waves eliminated her tremor.
Using Light Beam Treatment
Focused Ultrasound is a form of functional neurosurgery that targets specific structures deep in the brain to change it, restore function or stop a tumor. It is an alternative treatment option for those who don't respond or have stopped responding to conventional medication treatment. The procedure uses a transducer to force beams of sound waves to converge at one point, raising the temperature and destroying tissue. Before undergoing high-intensity focused ultrasound treatment for essential tremors, patients must have their heads shaved to avoid trapping air in hair follicles.
The patient then experiences MRI and CT scans, so the physicians can utilize the resulting images to map the brain structure and the target. Neurosurgeons may perform what Dr. Jeff Elias refers to as "test shots ensuring focus at the target," a focused ultrasound medium that instructs beam numbers that should be used for the treatment. Elias, a neurosurgeon at UVA Health who treated Hric, was the first to use ultrasound waves to heal essential tremors. He was in charge of the crucial clinical trials in 2011 that led to this procedure receiving regulatory approval in the United States.
Hric's tremor was significantly reduced after four 11-second treatment doses. The process took less than two hours, most of which was spent mapping the target's brain and testing it. Hric had difficulty drawing within the confines of circles before. She was able to color within the lines thanks to focused ultrasound.
Effects of Focused Ultrasound (Pros and Cons)
Dr. Nir Lipsman, a scientist at Sunnybrook Health Sciences Centre in Toronto and director of Sunnybrook's Harquail Centre for Neuromodulation, stated that focused ultrasound treatment is generally available to everyone with an essential tremor disease and that does not respond to prescription. According to Dr. Noah Philip, a psychiatry and human behavior professor at Brown University's Alpert Medical School, people who cannot undergo MRI scans due to claustrophobia or have metal in their bodies are not eligible for focused ultrasound. At the VA RR&D Center for Neurorestoration and Neurotechnology, Philip also serves as the lead for research into mental health.
Lipsman stated that the benefits of focused ultrasound are permanent. However, after one year, some of these patients will experience a rebound or recurrence of their tremors; the reason for this is unknown. Such a return can also occur with medical treatment, however - which is why some fundamental quake patients go to centered ultrasound in any case.
Moreover, a 2022 Elias study indicates that some patients have experienced the benefits five years after receiving the focused ultrasound. The significance of the mapping and testing portions of the procedure is due to the potential negative effects of focused ultrasound. Long-term harm can come to a patient's balance and stability if the wrong area is targeted or treated excessively. Lipsman added that the most common risk the neurosurgeons encounter in patients is a temporary numbness or tingling that can occasionally occur in the treated arm or in the lip area, which, most of the time, fades with age.
Promising Treatment
Other risks may include feeling a little unsteady on single feet after the procedure, but these are only temporary. Furthermore, he clarified that doctors do not use a general anesthetic or place patients in hospitals for this procedure. Focused ultrasound technology is currently used worldwide at various stages, including clinical trials and regulatory use that has been approved. Kassell mentioned that the field is expanding and has more than 170 clinical uses, including those for neurodegenerative disorders and brain, lung, prostate, and other tumors.
Kassell also stated the effect of the ultrasound treatment in real-time while it is being administered, whereas the effect of the radiation treatment is invisible while the treatment itself is being administered. Yet, the effects of radiation may not become apparent for several weeks or months. Based on a small 2020 study by Lipsman and a group of researchers, treatment for depression and obsessive-compulsive disorder is possible. Focused ultrasound was safe and effective in reducing major depression and OCD symptoms. However, more analysis is required.
Lipsman stated that one limitation of focused ultrasound is that not all skulls are created equal. He added that the ability of ultrasound to encompass through the skull is greatly affected by its density. This is uncommon; there are some patients who, despite the surgeons' best efforts, are unable to create a brain lesion successfully. Ultrasound cannot travel through the skull. Therefore, that is a technical limitation of the technology, which they have actively addressed.
Although focused ultrasound is not available for every condition, experts expressed optimism that "medicine's best-kept secret" will one day be the standard treatment. Kassell believes that in ten years, focused ultrasound will be a mainstream therapy that affects millions of patients worldwide every year.
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