For patients like 77-year-old Lou Pandolfe of West Hartford, Connecticut, treatment for benign essential tremor was once limited to partially effective medications or invasive and complex brain surgery. Neither of those options were good ones for Pandolfe, whose tremor had grown so severe over the past two decades that simple daily tasks like drinking a glass of water or holding a screwdriver proved problematic. So a cutting-edge, noninvasive ultrasound procedure offered at Brigham and Women’s Hospital, which can safely offer permanent relief within just a few hours, sounded like a medical miracle.
Pandolfe is the 53rd person to receive the treatment, called focused ultrasound, from Rees Cosgrove, MD, Brigham neurosurgeon and the only one in New England offering the procedure. It works by targeting the brain’s thalamus—where a disruption in signals is typically responsible for tremor—with an ultrasound beam guided by preoperative brain mapping and intraoperative MRI. From a control room adjacent to the patient, the surgical team identifies the target, specified within a half a millimeter, then ablates the area of the thalamus with high-intensity ultrasound to interrupt the misfiring signals—and, hopefully, arrest the tremor.
To qualify for the procedure, patients must be over 21, have had a subpar response to medication, and undergo a preoperative consult to determine if the skull’s density is thick enough for the ultrasound to penetrate; around 15 percent of patients will not qualify based on skull density.
For Pandolfe, the procedure—the result of years of research and clinical trials that originated at the Brigham—offered immediate relief from the tremor on his right side, a fact that continues to amaze him. “They told me to take a drink — and I did. I was more than elated.”
As these benefits continue to accrue to more patients with both essential and Parkinson’s associated tremor—the two conditions for which the approach is FDA-approved—researchers at the Brigham are continuing to look at possible expanded applications for Alzheimer’s, brain tumors, ALS, and other conditions.
Read more in The Boston Globe.