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Procedure to prevent Parkinson’s tremors carried out for first time in Scotland

An ultrasound thalamotomy, which gives Parkinson’s patients hope of regaining independence, was carried out for the first time in Scotland this month, by a team from the University of Dundee’s School of Medicine.

The ultrasound thalamotomy is an incision-free procedure that uses high-intensity focused ultrasound to create a lesion in a part of the brain known as the thalamus, which controls a person’s movements.

Dr Tom Gilbertson, consultant neurologist and honorary senior lecturer at the University of Dundee, one of the world’s leading centres for Parkinson’s research, called it “a milestone moment” for Scottish medicine and said it has a “life-changing impact” on patients. 

Dr Anhar Hassan, Consultant Neurologist at Beaumont Hospital and Beacon Hospital and Associate Professor at UCD School of Medicine, gives some further context on the procedure:

“MRI guided focused ultrasound thalamotomy (MRgFUS) was initially used as a specialized laser treatment for certain cancers. In 2016, it was approved in the USA for treatment of the brain for essential tremor. In Parkinson’s Disease it can treat disabling hand tremor. However, the machine is not yet available in Ireland.

“MRgFUS is a laser surgery to one side of the brain (thalamus) performed while awake in an MRI machine. It is a one-off treatment with immediate benefit. It only treats tremor, and does not help other symptoms of stiffness, slowness, balance or walking. It has potential side effects of worsening balance, arm clumsiness or tingling, that can be transient or permanent in up to 15% of patients. The benefit can last a few years but may wear off, and the treatment cannot be repeated. MRgFUS may be an option for certain patients where one-sided tremor is the major complaint,  they are not candidates for DBS, are unable to travel frequently to appointments,  or have a strong preference for this procedure.  There is discomfort during the procedure, as patients need to lie flat for hours in an MRI machine, have their head shaved, and the head is placed in an ice bath to avoid overheating from the laser.

“In contrast, deep brain stimulation is a surgery that can treat bothersome tremor, bothersome dyskinesia, and increase on-time.  The surgery implants wires in the brain and a battery/programmer in the chest, followed by clinic visits to program the device and optimize symptoms. It can be adjusted overtime to improve worsening tremor and mimimize side effects. 

“Generally speaking, for patients with severe bothersome Parkinson’s tremor, it is important to see a Parkinson’s expert to optimize management. The expert can decide if the patient should be referred on for deep brain stimulation evaluation, which is currently available in Ireland. If MRgFUS becomes available in Ireland, it will be another helpful treatment option for carefully selected patients.”

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