Helping patients regain the ability to dress and feed themselves, or just live a more active and independent lifestyle, is extremely rewarding.
Novant Health neurological surgeons have treated more than 300 patients with magnetic resonance (MR)-guided transcranial high intensity focused ultrasound thalamotomy since implementing the method in 2020. While the majority of those cases involved patients with essential tremor, the treatment can also be applied to patients with tremor-dominant Parkinson’s disease.
“This technology gives a treatment option to a lot of patients who otherwise would not be good candidates to undergo — or would be reluctant to undergo — a more invasive treatment,” said Charles Munyon, MD, Novant Health neurosurgeon based in Charlotte.
“This is an option for patients who have essential tremor or tremor-dominant Parkinson’s disease that is not responding to medication and is causing significant detriment to their quality of life,” Dr. Munyon said. “They may have problems eating and drinking, playing musical instruments, writing, dressing or performing hygiene tasks. For any given patient, what’s important to them may be different, but we work with them when their tremor is getting in the way of things they want to do.”
Here are the top benefits of focused ultrasound.
The results are immediate, with up to 90% reduction in tremor.
“We are usually looking for 70% to 90% reduction in tremor,” Dr. Munyon said. “Sometimes we can do better. Usually that’s enough to let people go back to eating and drinking even difficult foods, regain their ability to write legibly and to do tasks around the house. Some of my patients have returned to art and even brought me a few sketches.”
There’s no incision necessary.
“We use focused sound waves to make a small hole in the thalamus where the circuitry that drives tremor is running,” said Dr. Munyon. “Because those sound waves can be transmitted through the scalp and skull, we don’t have to make any incisions. And because we’re using heat to create the lesion, we can use the MRI essentially as a thermometer. We can see where the temperature in the brain is changing and we can make sure that it’s exactly where we want the temperature to change.”
The treatment is a low-risk, outpatient procedure.
Dr. Munyon and his team perform focused ultrasounds in an MRI suite at Novant Health Mint Hill Medical Center. Without an incision, there is no risk of infection and there is no significant risk of bleeding. Neurosurgeons perform the procedure in conjunction with MRI technicians, a physician assistant who helps with patient prep, as well as a nursing team supporting the patient before and after the procedure.
The procedure is quick, lasting about an hour and a half.
Not only is the procedure fast, but the goal is for it to be a onetime procedure for each patient. “Some may undergo an additional focused ultrasound procedure if the effect isn’t quite as good as the team was hoping for, or if we see something that can be improved upon,” Dr. Munyon said. “Initially, the procedure was limited to one side of the body, but the FDA has now approved staged bilateral treatment, so patients can now get treatment on one side and then, about nine months later, they can undergo treatment on the other side.”
Side effects are minimal and tend to dissipate in about six weeks.
Side effects are temporary for most patients and can include a change in taste, mild slurring of speech, numbness or tingling in the lips, tongue or mouth, and mild drifting when walking.
“There is a 3% risk of long-term side effects associated with this treatment,” Dr. Munyon said. “For most patients, this is manageable, such as discoordination or imbalance, numbness or unpleasant tingling in the face, arms, legs, or lips on the side of the body that was treated.”
The procedure makes it possible for patients to finally return to more active lifestyles.
“Many tremor patients have suffered for years or even decades with a debilitating and progressive condition,” Dr. Munyon said. “Helping them regain the ability to dress and feed themselves, or just live a more active and independent lifestyle, is extremely rewarding.”
The Novant Health team is always happy to work with referring neurologists and to assess patients who are being managed by a primary care physician.
To work with Novant Health Brain & Spine Surgery - Cotswold in Charlotte, or to refer a patient, call 704-316-3070.
