Travis Tierney, MD, a Neurosurgeon at Sperling Medical Group, talks about a treatment for Essential Tremor.
Interview conducted by Ivanhoe Broadcast News in November 2017.
Tell us about essential tremor, is this a very serious problem in this country, does it affect a lot of people?
Dr. Tierney: Essential tremor is the most common movement disorder, about three times more common than Parkinson’s disease. It tends to affect people who are older, there is a family history; it can affect patients who are younger, but generally people start to notice the effects of essential tremors when they are about 50 years old and despite medication it will progress over time.
So this type of technology, tell us what it is and what you were doing in there with Harriett and all?
Dr. Tierney: There are several ways to treat essential tremor, and one of them is to do a procedure called the thalamotomy, which has been with us for a long time. It was designed first in the 1950’s using electrical probes you have to place within the brain. We are essentially performing the same procedure without making an incision and with sound, so we are focusing a sound array which is basically a thousand speakers aimed at one spot much like you would focus the rays of the sun with a lens. We are doing that with sound so that it is focused in the precise spot in the brain where the tremor cells are and that is in the part of the brain called the thalamus and in the sub part of the thalamus, it is called the ventricle intermediate nucleus of the thalamus and we know that if we destroy that part of the brain; that we also destroy the tremor.
Is this something where the tremor is gone for good doctor and you only treat one side or the other or both sides, or how does that work?
Dr. Tierney: You could expect 70 to 80 percent tremor reduction, in some cases we may get what is called tremor arrest and the tremor is gone. We now have data out through two years to show that the procedure is durable, right now we have not treated the second sides; we can only treat one side at the moment; but we will begin studies shortly to see if we can treat the second side.
Any side effects or anything that can hurt the patient in all of this? I know you are dealing with brain so it is very technical and targeted area, any concerns for the patient for this procedure?
Dr. Tierney: The reason that I like focused ultrasound is because it has a very low risk of stroke, bleeding, and infection; the alternative to focused ultrasound is deep brain stimulation that carries those risk albeit a very low rate, but they are still there. The major side effects of focused ultrasound are numbness and tingling on the side of the body that we have treated, and for the most part we found that those are transient. A subset of patients also has some difficulty walking; they have been a little bit wobbly after the focused ultrasound procedure. If you think about the risk you really have to think about risk of ultra focused ultrasound verses the alternative procedure, which is deep brain stimulation and although, those risks are a low they are also more serious. The problems that we have seen with focused ultrasound are more common but they are much less serious.
And for the most part this is an outpatient procedure, the patient comes in and goes home in the same day and can basically do their usual activities?
Dr. Tierney: Yep, the patient comes into the clinic, we see them and we do the treatment that day and they are discharged to home. Usually I see them in clinic the following day to make sure they are doing okay and then I will see them back in approximately three months to do another clinical investigation and to get MRI scans that we can see where the thalamotomy was placed, but patients can usually get back to their activities of daily living and hopefully at a better pace then what they had before that week.
And unfortunately right now this is not covered by insurance, is it doctor?
Dr. Tierney: It is not, no it is not. It is a procedure that is new and there are mechanisms that have to be gone through so that the center for Medicare group in Washington will make a payment to hospitals and then a particularly large insurance like Blue Cross and Blue Shield will match that, but that process is still ongoing, so right now this is fee for service.
Did we forget anything that you find that is really important that we forgot to ask you about this procedure and the patients?
Dr. Tierney: Well I think one of the most important things is patient satisfaction and we measured that when we did our first trial with a questionnaire and what that showed us was that the satisfaction with the outcomes were equivalent or better than deep brain stimulation. The real reason I like focused ultrasound is because of the safety profile that we just talked about. It would be great to treat the contra-lateral side we mentioned and we are working on that and I think if we were able to do that successfully, without risking speech that this could be a very nice non-invasive way to treat essential tremor that we did not currently have until about five years ago.
And you found out about this procedure because you did it on a pediatric patient at Miami Children’s Hospital who had epilepsy?
Dr. Tierney: That is right.
And the treatment there could you talk a little about that? For epilepsy and a brain tumor?
Dr. Tierney: Yeah, this is one of our “eureka” moments we realized we could make very discreet lesions within the brain and treat essential tremor, and at Miami Children’s we thought if you could do that, then we could probably tackle pediatric brain tumors. They are larger than the targets that we are going after with thalamotomy by a lot, and we thought if we could destroy the tumor that we would get rid of some of the problems that are associated with tumors and one of them is epilepsy. Our first patient happened to have a tumor associated with epilepsy, we destroyed the tumor non-evasively and her seizures, that would have only been possible with an open type of surgery, so we are investigating focused ultrasound in the pediatric population because we want to be able to treat them non-evasively and because we want to be able to treat them without ionizing radiation.
Is it truly a medical breakthrough?
Dr. Tierney: That is what we hope to show. This in the early days and it is hard to look into a crystal ball down the road but one of our goals is to begin to replace a scary tactic, radiation, in the pediatric population with focused ultrasound. We think it will be a lot safer and to start replacing x-rays which carry a risk of radiation exposure for example, with a diagnostic ultrasound, which we have done extensively at Miami Children’s.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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