Essential tremor (ET) is the most common type of tremor and the most frequently encountered movement impairment. Also known as benign tremor or familial tremor, ET affects about 10 million Americans. Although it is not life-threatening, ET can negatively impact a patient’s daily activities.
This is particularly true of tasks involving fine movements of the hands, such as crafting, writing, painting, and personal care. Essential tremor is a progressive disorder, meaning it worsens over time. Fortunately, Sheba Medical Center now offers an effective and non-invasive treatment for ET – focused ultrasound therapy (FUS).
While the signs of ET are most obvious in the hands, this disease can affect the entire body. In addition to hand tremors, patients sometimes show symptoms in the face and jaw. This can make speaking or singing difficult. ET can even degrade balance and the ability to walk.
Unlike tremors from Parkinson’s disease, ET is an active tremor. This means it comes on when the patient begins to move. It is generally not present at rest, for example during sleep. Yet, because ET is an active tremor, it impairs the ability to perform a daily routine or hobbies.
The complete causes of ET are still unknown. However, there is almost certainly a hereditary component. In other words, ET is caused by a person’s genetics. Age is also a factor. Although ET can appear in the very young, it most commonly manifests in the elderly. People over age 65 are the most likely to have this disorder.
ET is often associated with other neurological disorders. These include Parkinson’s disease, dementia, and mental impairment. ET is most likely to occur in conjunction with these other conditions in elderly patients.
Age is also a factor. Although ET can appear in the very young, it most commonly manifests in the elderly. People over age 65 are the most likely to have this disorder.
Focused Ultrasound Treatment (FUS) in Israel
There are several treatments for ET available, some more effective than others. Medication remains the usual first choice for ET treatment. However, roughly 30% of patients show no response to pharmacologic therapy alone.
One effective treatment, used since the 1950’s, is a surgery known as a thalamotomy. This operation destroys a small part of the brain called the thalamus. The surgery must be performed on both sides of the brain in order to resolve tremors on each side of the body. Unfortunately, a thalamotomy often produces many unintended effects, such as gait and speech difficulties.
Another option is deep brain stimulation (DBS). While DBS does not have as many side effects as a thalamotomy, it still involves surgery. Electrodes are placed deep into the brain in order to apply heat to the areas causing essential tremor. The drawbacks include an invasive operation and the need to regularly replace a battery.
Medical research has recently provided another possibility – focused ultrasound (FUS). Focused ultrasound is FDA-approved, but is still only available at very few institutions in the US. Sheba Medical Center offers ET patients this advanced treatment with its many advantages.
First off, FUS is non-invasive. There is no electrode placement and absolutely no surgery is needed. Dr. Simon Israeli-Korn, a specialist in movement disorders and senior physician in the Neurology Department at Sheba Medical Center, puts it succinctly:
“The only knife the patient sees is when their head is shaved.”
FUS uses focused ultrasound waves to precisely ablate, or destroy, the desired brain area. This allows ET to be controlled with no risk of infection and no need for an operation. As Dr. Israeli-Korn stated, “It’s quite futuristic and amazing to see.”
Furthermore, FUS is guided by MRI. Both of these techniques use no radiation, unlike CT scans and x-rays. This further reduces the risk to the patient.
There is no age limit for FUS therapy. Each patient is evaluated on a case by case basis. While FUS may not be appropriate for every patient, this novel treatment offers hope for millions afflicted with essential tremors.
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