A scalpel-free alternative to brain surgery has the potential to benefit people with Parkinson’s disease symptoms who are much more severe on one side of the body, a new study suggests.
More testing is needed, but the approach, which uses a technology called focused ultrasound, may offer a new option for patients with symptoms of poorly controlled medication and those who don’t. may or may not want to undergo traditional brain surgery.
“This small brain region, the subthalamic nucleus, had a large and strong effect on parkinsonian symptoms when we targeted it with precise, focused ultrasound energy,” said researcher Jeff Elias, MD, neurosurgeon at UVA Health and pioneer in the range of focused ultrasound. “The key to adopting this new approach is to further develop the technology to ensure reliability and safety. “
About focused ultrasound
Focused ultrasound offers an alternative that is less aggressive than traditional surgical procedures. The technology absorbs sound waves inside the body, just as magnifying glass directs light. This allows doctors to prevent faulty brain circuits or destroy unwanted material. Magnetic-resonance imaging (MRI) allows physicians to monitor the procedure in real time – and make adjustments as needed to get the best patient results.
To see if the technology could benefit patients with “asymmetrical” Parkinson’s symptoms, Elias and Binit Shah, MD, from the UVA Department of Neurology, collaborated with the Centro Intregral de Neurociencias in Spain to develop the method evaluated in 40 volunteers in a randomized, double-blind study. . Twenty-seven study participants received treatment with focused ultrasound, and a further 13 received similar treatment, so that the researchers could compare the results between the actual procedure and the placebo. The average age of the study participants was 57.
Volunteer scores before and after the procedure were assessed at a scale of 1–44. Those who received the targeted ultrasound method saw an improvement of 10 points, and those who received the sham treatment saw a difference of less than two points.
The study also looked at the safety of the procedure. Side effects included unwanted movements, muscle weakness, speech disturbances and difficulty walking. In most cases, these were temporary, but some effects continued in six patients a year later.
The results warrant further studies in larger numbers of volunteers performed over longer periods of time, the researchers concluded.
Parkinson’s disease affects patients in more ways than just tremor. The FDA’s standard approval for targeted ultrasound in Parkinson’s disease only treats tremor. Focusing on this new area will allow us to improve vibration but also gain more overall benefit for our patients than we were previously able to achieve. “
Binit Shah, MD, UVA Department of Neurology
About ultrasound examination with UVA focus
UVA has been at the forefront of research into the potential of technology to treat disease. For example, the federal Food and Drug Administration approved a targeted ultrasound for the treatment of essential tremor, a common movement disorder, based on Elias’ innovative research. His work also paved the way for the FDA to approve the technology for the treatment of tremors caused by Parkinson’s disease.
Other researchers at UVA are examining the potential of the technology to treat a wide variety of conditions, including epilepsy and breast cancer.
Results published
Elias and his colleagues have published their latest results in the acclaim New England Journal of Medicine. The research team included Raúl Martínez-Fernández, Jorge U. Máñez-Miró, Rafael Rodríguez-Rojas, Marta del Álamo, Binit B. Shah, Frida Hernández-Fernández, Jose A. Pineda-Pardo, Mariana HG Monje, Beatriz Fernández- Rodríguez, Scott A. Sperling, David Mata-Marín, Pasqualina Guida, Fernando Alonso-Frech, Ignacio Obeso, Carmen Gasca-Salas, Lydia Vela-Desojo, Elias and Jose A. Obeso.
The research was supported by InSightec, the maker of focused ultrasound technology; Charlottesville-focused Ultrasound Foundation, which long-term support of UVA-focused ultrasound study; Fundación MAPFRE in Madrid; Hospitales de Madrid Fundraising; and a University of Virginia Center of Excellence grant. Elias revealed that his division at UVA has received research funding from InSightec, but the company had no role in the design or study of the study. A full list of the author’s publications is included in the paper in the New England Journal of Medicine.
Source:
University of Virginia Health System
Magazine Reference:
Martínez-Fernández, R., et al. (2020) A randomized controlled trial of ultrasound subthalamotomy for Parkinson’s disease. New England Journal of Medicine. doi.org/10.1056/NEJMoa2016311.