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A breakthrough minimally-invasive procedure for the treatment of Parkinson’s disease and essential tremor is now in use at Sheba Medical Center in Israel.
Focused ultrasound (FUS) uses ultrasound energy to perform operations without physical incisions, drilling into the skull, and insertions of electrodes into the brain.
Parkinson’s disease is a degenerative neurologic disease that affects about 1% of people over age 60. While it is more common in the elderly, 10% of the patients are affected before the age of 40 years.
Parkinson’s disease is caused by a combination of both genetic and environmental factors.Resting tremor in one or more limbs is the most obvious symptom associated with Parkinson’s, and often is the first symptom that is noticed. Parkinson’s patients may exhibit many additional symptoms besides tremors, such as problems with walking, rigidity of limbs and slowed movements.
Essential tremor is the most common disorder that causes tremor affecting 5% of people over age 40 years. It is usually hereditary, namely it “runs in families”. The tremor, in contrast to the tremor of Parkinson’s disease, is more obvious during action, for example when holding a piece of paper, writing, drinking or using eating utensils. In most patients with ET, the tremor is the only symptom that disturbs the patients and it is usually the tremor of the dominant hand that causes the most problems.
Medication is the first choice for Parkinson’s treatment, but Parkinson’s patients don’t respond well to drugs or have side effects. In Essential tremor, the response rate to medications is less than Parkinson’s disease and up to 30% may not tolerate medications or may have an unsatisfactory response. In these cases, surgical treatment may be considered.
Before the arrival of FUS, surgical options for Parkinson’s treatment included thalamotomy and deep brain stimulation (DBS).
Both these options are considered minimally invasive although they involve incisions, use of drills to open a small hole in the skull and the insertion of one or more electrodes into the brain. In the case of DBS, the hardware is implanted into the brain and a pacemaker similar to a heart pacemaker is implanted into the chest wall.
The procedure uses focused ultrasound waves to precisely destroy targeted brain tissue that is abnormal in patients with tremor due to Parkinson’s disease or Essential Tremor.
FUS carries no risk of infection and is guided by MRI allowing extremely high spatial accuracy as well as excellent control of heating of the target brain tissue.
To allow the safe transmission of ultrasound energy the head needs to be completely shaven. To allow the accurate treatment a frame is used to fixate the patient’s head to the special ultrasound helmet and treatment system.
While there is still no cure for Parkinson’s or Essential tremor, FUS represents an excellent method of controlling the tremor in these disorders. Out of the patients treated thus far at Sheba, 92% have shown improvement of tremor on a clinical disability scale. This includes such dramatic effects as being able to write effectively after treatment.
If you or a loved one is suffering from the significant tremor caused by Essential tremor or Parkinson’s disease, contact Sheba right away to learn more about FUS treatment.
FUS is suited for Parkinson’s or Essential tremor patients who have undergone therapy with medication but still have a remaining tremor. While there is no upper age limit for treatment, certain conditions will preclude FUS therapy, including the inability to have a MRI and coagulation or bleeding problems.
Sheba Medical Center sets the standard for excellence in patient-focused care. Recently, Newsweek included Sheba on their prestigious list of the Top Ten Best Hospitals Worldwide. This endorsement recognizes Sheba as a leading force in medical science and biotechnological innovation – maximizing the latest technologies while always providing holistic, outstanding healthcare. Sheba is strongly committed to delivering personalized, expert medicine to everyone from all over the world.
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Every patient receiving FUS treatment will first undergo a comprehensive evaluation at Sheba, including examination by a neurosurgeon and a movement disorders neurologist. Additionally, a psychological evaluation will be necessary.
The patient will need to be admitted to the hospital the day before the treatment. On the day of treatment, the patient will have their head shaved and be set up in the MRI machine.
The MRI images are monitored in real time during the treatment to ensure both safety and effectiveness. Pain and anti-nausea medication are available if needed.
Patients usually notice an immediate improvement in tremor symptoms, with the tremor sometimes disappearing altogether.
The FUS treatment team includes three expert surgeons, Dr. Roberto Spiegelman, Dr. Israeli-Korn, and Dr. Zion Zibly.
Dr. Zibly joined the Functional and Stereotactic Neurosurgery Service years ago after completing training in the Cleveland Clinic in the USA.
Dr. Spiegelmann is the Head of the Functional Neurosurgery Service and the Israeli neurosurgeon with the longest experience in stereotactic surgery for movement disorders. He was trained both in the US and Israel and has performed hundreds of surgical procedures for the improvement of patients with movement disorders since the 1990’s.
A specialist in movement disorders and senior physician in the Neurology Department.
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