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07.02.2019 08:10:42
Not long ago it was impossible for Dieter C. and Klaus Y. to sign by hand, as their hands shook very much because of difficult-to-treat essential tremor. They found help at the University Hospital Bonn. A team of neurologists, radiologists, and neurosurgeons has recently launched a high-precision focused ultrasound system guided during use by a magnetic resonance imaging (MRgFUS) device. Doctors use the first device of its kind in Germany for targeted treatment of difficult-to-treat, incurable essential tremor and tremor resulting from Parkinson’s disease, without opening the skull. Dieter C. and Klaus Y. were the first patients whom they successfully cured with excellent results as part of research work.
“Where the ideal target is located, we can safely find out by increasing energy during treatment under MRI guidance,” says prof. Dr. Ulrich Wüllner, Head of the Division for Movement Disorders in the Department of Neurology, the University Hospital Bonn. So, step by step, the team of neurologists, radiologists and neurosurgeons move further by touch and by using reversible suppression with temperatures below 50 degrees Celsius check whether the tremor will pass as it is desired (the patient during the operation is awake). When the target is found, the temperature is raised to 55-60 degrees, thereby deactivating the spot. At the same time, thanks to MRI guidance, the accuracy is very high,” says prof. Hans Schild, Head of the Department of Radiology at the University Hospital Bonn.
According to the first international research, by combining focused ultrasound and MRI guidance during an intervention on half of the head, the shaking of the opposite side of the body is considerably reduced. The great advantage of the new technique which is that there is no need to open the skull, like in the case of deep brain stimulation, is opposed to the disadvantage which is that deactivation of brain tissue, unlike deep brain stimulation, is irreversible. In addition, according to current knowledge, bilateral tremor treatment by using MRgFUS is likely to be associated with an increased risk of speech impairment. “According to the results obtained earlier, the technique may become an alternative for the recognized deep brain stimulation, first of all, for high risk surgical patients or for those who have refused deep brain stimulation because of the necessary surgical intervention,” says Dr. Hartmut Vatter, Head of the Department of Neurosurgery at the University Hospital Bonn. “However, further research is needed, which we are also doing.”
