May 14, 2023

No Comments The results of a major international trial to test a high-tech no-scalpel approach to treating movement problems caused by Parkinson’s disease have been published in the prestigious New England Journal of Medicine. Jeff Elias, MD, pioneered the use of focused ultrasound for the treatment of essential tremor and Parkinson’s disease. Image Credit: UVA Health UVA neurosurgeon Jeff Elias, MD, and his collaborators have examined the benefits and risks of using focused ultrasound to target a deep area of ​​the brain called the globus pallidus. The researchers wanted to see if focused sound waves could improve the trial participants’ ability to move and reduce the unwanted tremors and stiffness associated with Parkinson’s disease. Of the 69 patients who received the procedure in the randomized trial, almost 70% responded to the treatment. Thirty-nine participants who received the procedure continued to see significant benefits three months later, and 30 of those evaluated after one year continued to see benefits. The procedure, the researchers conclude, could be particularly helpful for patients who are ineligible or unwilling to receive deep brain stimulation, a surgery that implants electrodes deep into the brain to achieve the same symptom management goals. The results of the focused ultrasound trial were shared with the federal Food and Drug Administration ahead of publication and were an important consideration in the agency’s decision to extend the technology’s approval for the treatment of the disease. of Parkinson’s in 2021. This study holds promise for patients with Parkinson’s disease and other neurological conditions. Ultrasound was precisely focused deep within the brain to alter one of the abnormal circuits in Parkinson’s disease. But it is important to understand that the treatment improved the neurological symptoms of PD and did not alter its course. Ultimately, we hope to one day cure Parkinson’s disease. Jeff Elias, MD, UVA neurosurgeon About Focused Ultrasound The focused ultrasound procedure focuses sound waves inside the brain to disrupt faulty brain circuits, like the way a magnifying glass can focus light. Unlike deep brain stimulation, the minimally invasive procedure does not require any incisions or opening of the skull. The procedure is guided by magnetic resonance imaging (MRI), so doctors can locate exactly the right place in the brain before making permanent changes. Participants in the randomized Parkinson’s disease trial were assigned to receive either the focused ultrasound treatment or a harmless – or “sham” – sham procedure. A total of 69 received the real treatment and 25 received the sham procedure. Participants’ symptoms were then rated using two common rating scales, one for patients on medication and one for patients without medication. Sixty-nine percent of procedure recipients improved by at least three points on one or both rating scales. This compares with only 32% (seven participants) in the control group. In the control group, significant improvements were seen only in patients on medication. Side effects reported by treatment recipients included slurred speech, difficulty walking and loss of taste. Loss of taste and difficulty walking were mild and resolved on their own. One participant continued to experience slurred speech a year after the procedure, the researchers report. Elias’ pioneering research into the use of focused ultrasound for Parkinson’s disease is just the latest in his more than decade-long effort to harness the technology’s vast potential. His earlier work prompted the Federal Food and Drug Administration to approve focused ultrasound for the treatment of essential tremor, a common movement disorder, in 2018. This approval represented a turning point for the technology and helped spur further research to UVA and elsewhere. Elias and his colleagues at UVA Health continue to explore the many possible applications of focused ultrasound. For example, UVA Health last year partnered with the Charlottesville-based Focused Ultrasound Foundation – a longtime supporter of UVA’s focused ultrasound research – to launch the world’s first center dedicated specifically to the combination focused ultrasound with immunotherapy to improve the body’s ability to fight cancer. Other potential applications include using the technology to open up the brain’s natural protective barrier to allow, for the first time, targeted drug delivery for neurological conditions such as Alzheimer’s disease. UVA’s transformative work with focused ultrasound was recently brought to the world’s attention by CNN’s Sanjay Gupta in a story that featured a procedure carried out by Elias and his team. About Research The Parkinson’s disease research team consisted of Vibhor Krishna, Paul S. Fishman, Howard M. Eisenberg, Michael Kaplitt, Gordon Baltuch, Jin Woo Chang, Wei‑Chieh Chang, Raul Martinez Fernandez, Marta del Alamo, Casey H. Halpern, Pejman Ghanouni, Roberto Eleopra, Rees Cosgrove, Jorge Guridi, Ryder Gwinn, Pravin Khemani, Andres M. Lozano, Nathan McDannold, Alfonso Fasano, Marius Constantinescu, Ilana Schlesinger, Arif Dalvi and Elias. Elias is a consultant for Insightec, the manufacturer of focused ultrasound technology; a full list of author disclosures is included in the document. Financial support for the Parkinson’s disease trial was provided by Insightec. 2023-05-13 17:43:23