- Researchers say a targeted ultrasound treatment has shown promise in reducing symptoms associated with Parkinson’s disease.
- They said participants in a study who received the treatment showed improvement in mobility as well as a reduction in tremors.
- Experts note that other treatments for Parkinson’s include deep brain stimulation, medications, and lifestyle factors such as diet and exercise.
Targeted ultrasounds might help reduce tremors, mobility issues, and other physical symptoms associated with Parkinson’s disease, according to a recent study published in the New England Journal of Medicine.
Researchers at the University of Maryland School of Medicine worked with 94 people previously diagnosed with Parkinson’s disease.
The scientists randomly assigned participants to one of two groups. They received either:
- A focused ultrasound to ablate a targeted region on one side of the brain.
- An inactive procedure that offered no medical benefit.
Researchers reported that about 70% of the treatment group had positive outcomes three months after the procedure compared with 32% in the control group.
They added that two-thirds of those with positive results experienced a successful response one year after receiving the ultrasound treatment.
Focused ultrasound works by heating a point within the brain to cause a lesion.
Ultrasound waves typically do not cause tissue damage.
However, when ultrasound waves are combined and focused on a particular spot, they form a lesion, according to the American Parkinson Disease Association.
“It is a minimally invasive neurosurgery,” said Dr. Rebecca Lalchan, DO, a neurologist and movement disorder specialist at NYU Langone Hospital – Brooklyn who was not part of the study.
“It uses high-frequency ultrasound using real-time MRI guidance to gradually deliver heat to a part of the brain involved in Parkinson’s disease. It creates a permanent lesion that disrupts signaling and improves movement in patients with Parkinson’s disease,” she told Healthline.
The lesion deactivates that region of the brain.
“It is a little bit as if this region was creating noise in the system so that other regions of the brain are unable to speak to each other properly,” said Dr. Jean-Philippe Langevin, a neurosurgeon and director of the Restorative Neurosurgery and Deep Brain Stimulation Program for Pacific Neuroscience Institute at Providence Saint John’s Health Center in California.
Once the noise stops, the other brain regions can communicate better,
The patient is awake during the procedure to allow the surgeon to monitor potential side effects. The medical staff may ask the patient to communicate as they check for tremors and other adverse effects.
The Food and Drug Administration has approved the use of focused ultrasounds to treat Parkinson’s tremors.
The American Parkinson Disease Association expects the approval to extend to additional symptoms, such as motor fluctuations and dyskinesias.
There are both advantages and disadvantages to the procedure, according to experts.
- It is non-invasive and does not require any incisions in the skull. There isn’t a need for wires or hardware to generate electrical pulses in the skull or chest. Because of the lack of incisions, there is a reduced chance of bleeding and infection.
- Focused ultrasounds require only one procedure. Deep brain stimulation, another effective treatment, requires two procedures – one to place an electrode in the brain and one to put a pulse generator in the chest. Additional procedures could be necessary to replace batteries or adjust settings.
- Focused ultrasounds work on one side of the brain. Deep brain stimulation is typically completed on both sides. As scientists conduct additional research, it might be possible for focused ultrasound to benefit both sides of the brain.
- Focused ultrasounds are once-and-done. Because this is a relatively new procedure, not as much is known about the long-term effects. With deep brain stimulation, the effects remain even when symptoms worsen, and if necessary, it can be adjusted to improve the effectiveness.
Deep brain stimulation has been around for decades and doctors treating Parkinson’s disease are familiar with the process.
Focused ultrasounds are relatively new. As research continues and medical professionals use the procedure regularly, it could become a better option.
Researchers said study participants who received ultrasound treatment experienced immediate improvement on at least three points on a standard assessment – measuring tremors, walking ability, and rigidity in the legs and arms.
They also had relief from dyskinesia, a common side effect of medications for Parkinson’s disease.
Side effects from the procedure included headache, dizziness, and nausea that typically disappeared one to two days after treatment. Some participants experienced slurred speech, walking issues, and loss of taste, but these disappeared within a few weeks.
Experts did say further studies and follow-ups are needed to determine how long the benefit lasts.
“It is unclear how long the benefits could last after completion of the treatment,” Langevin told Healthline. “This is a new way of treating Parkinson’s disease, so it is not entirely clear if the patients continue to benefit from the procedure several years after completion. This data is being accumulated currently.”
There isn’t a cure for Parkinson’s disease nor a treatment that can slow or stop the disease.
Doctors tailor therapy to an individual’s symptoms, and some options can help:
Treatment is complicated because medications used to treat the symptoms can also cause them.
“Dyskinesia can be caused by some of the most common drugs used to treat Parkinson’s disease, such as
Depending on a person’s symptoms, other medications such as dopamine agonists, enzyme inhibitors, amantadine, and anticholinergic drugs can be used.
Dopamine is a crucial factor in Parkinson’s disease.
“Not enough dopamine and we see slow and stiff movements, loss of facial expressions, decreased arm swinging, constipation, soft speech, and eventual a tremor that appears only while not moving,” said Dr. Brian Dalm, a neurosurgeon specializing in pain and functional neurosurgical disorders at The Ohio State University Comprehensive Cancer Center. “Too much dopamine and we can see excessive movements that we call dyskinesias.”
Deep brain stimulation is done via a surgical procedure where wires are Implanted in the brain and connected to an electrical device in the chest. Electrical currents are sent to stimulate areas of the brain responsible for movements. It can help stop some symptoms, such as tremors, slow movement, and rigidity.
Before the procedure, patients are evaluated.
“Typically, the patients should have a thorough assessment by a movement disorder neurologist to confirm candidacy,” Langevin said. “Additional tests that could be useful include a pre-operative MRI of the brain and a neuropsychological evaluation.”
Lifestyle therapies can also help.
Federal regulators have approved the ultrasound treatment for Parkinson’s for one side of the head.
There’s a reason.
“One side is always more affected than the other,” said Dr. Alessandro Di Rocco, a neurologist at Lenox Hill Hospital in New York. “This is a precision procedure and being off only by a few millimeters can cause damage in other areas of the brain and result in problems such as loss of sensation or cognitive issues.”
“Interestingly, even though you are only working on one side of the brain, you might see generalized improvement rather than only seeing it on one side,” he told Healthline.
Although targeted ultrasound is a new treatment for Parkinson’s, Di Rocco expects it to be a long-term solution.
“It is important to note that this is an advanced treatment,” he explained. “This is not meant to treat early Parkinson’s disease and is not a cure. Targeted ultrasound can be considered when other treatments, such as medications and lifestyle therapies, no longer work.”
People who previously had a stroke or brain damage are probably not good candidates for the procedure. Those who have a thick skull won’t receive the full benefit.
“A cat scan of the brain to assess skull density done before the ultrasound can show the thickness and density,” said Lalchan.
In the study, the Exablate Neuro device provided targeted ultrasound energy to the globus pallidus, a structure deep within the brain. MRI images helped the medical professional target the area and apply a high enough temperature to ablate it.
“This is considered a stereotactic neurosurgical procedure,” Dalm told Healthline. “The procedure starts with the placement of a stereotactic head frame. Once it is in place, a series of MRI images are obtained to ‘align’ the targeting of the ultrasound waves to ensure the shape and location of the lesion. After this portion is complete, the energy delivered is then increased to perform a test lesion to check for symptom improvement and to check for any possible side effects. No actual ablation of brain tissue has occurred at this time so any symptom improvement or side effects if seen are not permanent.”
“If things look good, then the energy delivered is increased to heat the brain tissue to a temperature that will create a permanent ablation,” Dalm added. “It is performed without sedation so the surgeon can monitor for any unwanted side effects. Generally, several permanent ablation treatments are performed to ensure adequate volume size to give the best possible treatment outcome. It is important to note that there are several factors that play into whether an ablation will be successful.”