For about 7 million Americans involuntary tremors are a constant problem. These tremors can interfere with just about everything — getting dressed, drinking a cup of coffee, writing, typing or using a cell phone. The trembling can be caused by Parkinson’s disease, but more often it’s caused by essential tremor, a benign and often inherited condition.

During a free health lecture, Kara Beasley, DO, a board-certified neurosurgeon with Boulder Neurosurgical and Spine Associates, described the symptoms of essential tremor and the latest treatments, including MR-guided focused ultrasound — a new, incisionless treatment.

Symptoms of Essential Tremor
Although essential tremor is non-life threatening, it can be severe in some people, impacting quality of life. Tremors associated with essential tremor can cause rapid, uncontrollable:

  • Shakiness of the hands and arms—the most common symptom—which occurs mostly during action or movement such as when writing, eating or holding a posture.
  • Small up-and-down or side-to-side head shakes.
  • Shaky voice.
  • Leg and feet tremors that can affect balance or the way you walk.

Dr. Beasley further explained, “Folks with essential tremor often will have no tremor at rest, but when they go to reach for something, they’ll develop a tremor. It’s usually greatest in the hand, and particularly at the end of the hand. The severity of the tremor typically worsens with age."

According to Dr. Beasley, while the exact cause is unknown, there can be a genetic component in many individuals experiencing these tremors.

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Treatment Options for Essential Tremor
Medication
Dr. Beasley stated that the first line of treatment for essential tremor is medication. However, many patients will experience unpleasant side effects with this option. In addition, essential tremor becomes progressively worse as you age. As a result, if a medication was initially effective, it may no longer adequately manage the tremor.

DBS: A Pacemaker for the Brain
Dr. Beasley explained that there are two types of surgical procedures that are considered therapy for essential tremor. One of these is Deep Brain Stimulation (DBS).

“DBS is a brain surgery that can help treat the debilitating symptoms of essential tremor when medication fails to provide consistent and adequate symptom control,” Dr. Beasley said. “We’ve been doing Deep Brain Stimulation at Boulder Community Health for several years and have a very active and successful DBS program.”

DBS involves implanting a device often described as a “pacemaker for the brain.” It is a two-step procedure.

“In the first step, the surgeon implants electrodes on either one side or both sides of the brain, depending on whether treatment is required for one or both sides of the body,” Dr. Beasley explained. “In the second step, the neurosurgeon implants a pacemaker-like neurostimulator under the skin, near the collarbone, and connects it to the electrodes with long lead wires passed under the skin and along the neck. The stimulator sends constant electrical impulses to the electrodes, which block the abnormal circuit in the brain causing the tremor.”

The primary advantage of DBS is that it can treat tremor that affects both sides of the body. In addition, clinical studies show that it can reduce hand tremor in 60 to 90 percent of essential tremor patients, improving their ability to do everyday activities.

However, the neurostimulator has a battery that lasts three to five years, which requires replacing the impulse generator but not the brain leads. Dr. Beasley stated the ongoing lifetime maintenance of DBS represents a significant drawback to this option.

Incisionless MR-Guided Focused Ultrasound
Boulder Community Health’s Foothills Hospital is the only medical facility in Colorado performing a revolutionary treatment for essential tremor – MR-guided focused ultrasound treatment.

"Focused ultrasound is a safe, incisionless and non-invasive treatment that uses focused beams of acoustic energy to heat and destroy a small, targeted area of tissue in the brain where tremor cells are located — all without harming adjacent tissues," said Dr. Beasley. "The focused ultrasound leads to the precise destruction of a portion of the involved circuit thereby decreasing tremors."

This nonsurgical procedure is performed while you are awake inside an MRI scanner. The scanner allows the physician to precisely plan the procedure and treat only the intended area.

According to Dr. Beasley, MR-guided focused ultrasound has multiple benefits:

  • Immediate reduction of hand tremor
  • No incisions required
  • Low-to-no risk of infection
  • No hospitalization
  • Fast recovery

MRI-focused ultrasound is currently only being performed to relieve tremor from one side of the body, typically for the dominant hand.

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Candidates for MR-Guided Focused Ultrasound
MR-guided focused ultrasound is approved for the treatment of essential tremor that cannot be controlled with medication. It is approved for men and women age 22 or older.

“Under 22, we like to let that tremor persist a little longer to ensure we’re not dealing with some other type of tremor,” Dr. Beasley explained.

You must also have the ability to tolerate the procedure without sedation. “We really can’t give conscious sedation in this procedure because the sedation medication actually dampens the tremor. We don’t want to give you a medication that might keep us from seeing your tremor and watch your tremor go away during the procedure,” she said.

MR-guided focused ultrasound treatments are covered by most health insurance plans, including Medicare.

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Results of MR-Guided Focused Ultrasound
Patients who have undergone MR-guided focused ultrasound have shown an immediate and significant reduction in tremor, resulting in improvement in performing daily activities such as eating, drinking and writing.

“For most patients, the result is immediate improvement in their hand tremor with minimal complications,” Dr. Beasley said.

She then discussed clinical trials published in the New England Journal of Medicine that demonstrated a 69.5 percent reduction in tremors three months after treatment. This improvement was still present two years after treatment. In addition, clinical evidence found that patients expressed a 47.4 percent quality of life improvement one year after treatment.

“This study shows us that not only does the treatment option make tremors better, but it also improves your quality of life,” she said.

Click here to view a PDF of slides shown during Dr. Beasley’s lecture on Advances in Treating Involuntary Tremors.

For more information about MR-guided focused ultrasound for essential tremor, please call (800) 720-0692 or email BCHTremorTreatment@insightec.com.


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