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Can Parkinson’s be treated with ultrasound?

An article in the Columbus Dispatch by JoAnne Viviano on Saturday December 24, 2016, reports as follows:

Ron Nickelson practiced tongue twisters Friday from his hospital bed at Ohio State University’s Wexner Medical Center.

“She sells seashells by the seashore,” he told his neurosurgeon, Dr. Vibhor Krishna, with a smile. “Rubber baby buggy bumpers.”

He wasn’t just showing off. He was letting the doctor know that his speech had improved since he underwent experimental surgery the day before, when Krishna created a tiny lesion in Nickelson’s brain to treat his Parkinson’s disease and the side effects of the medication he takes to manage it.

Krishna used no scalpel. There was no drilling, either. Instead, Krishna’s tool was a computer mouse that helped him deliver more than 1,000 high-intensity, focused ultrasound waves into Nickelson’s brain.

The 61-year-old editor from Colorado was the second patient to undergo the treatment at Ohio State as part of a clinical research trial. The facility is one of three U.S. hospitals conducting the research involving patients who experience dyskinesia, which causes the involuntary movement associated with Parkinson’s, as a result of taking medication used to treat the disease.

Currently, the “gold standard” treatment for Parkinson’s and similar conditions is deep-brain stimulation, in which electrodes are placed in the brain and controlled by a pacemaker-like device, Krishna said.

Placing the electrodes involves drilling into the skull — something many patients decline. The therapy being tested at Ohio State and other sites provides a noninvasive way to target the part of the brain that sends abnormal signals.

“It’s a paradigm shift. It’s something that patients wanted for a long time,” said Krishna, an assistant professor in Ohio State’s neurosurgery department.

“The first time I sat through a procedure, it was transformational. You could control a patient’s tremor without opening the skull, give them symptom control that’s able to make an impact on their quality of life.”

For his procedure, Nickelson’s head was shaved and fitted into a halo frame to hold it steady for an MRI. His scalp was submerged in water that helped conduct the waves and keep the head cool.

For more than three hours, he lay there as doctors and technicians viewed his brain, found their target and delivered a dozen 10- to 13-second rounds of ultrasound from a neighboring room. While each single ray does not cause damage to the brain, 1,024 rays converging in a pinpoint spot creates a lesion.

In Nickelson’s case, the lesion measures 6-by-4-by-5 millimetres and primarily treated the left side of his body by keeping those abnormal signals from being sent.

The team stopped several times during the treatment to determine if Nickelson’s symptoms were improving. Dr. Barbara Changizi, a neurologist, ran him through a battery of tests.

Among other things, he was asked to open and close his fingers, twist his arm and tap his foot.

She ranked the rigidity, tremor and slowness in his movements. Nickelson started with a score of 16, improving to 6 by the end of the treatments. Krishna expects he’ll improve even more over the next week.

The procedure already has been approved by the U.S. Food and Drug Administration to treat essential tremor, which causes involuntary shaking. Researchers hope this study will bring FDA approval for the treatment of Parkinson’s disease and medication side effects.

They eventually want to expand the technology to treat epilepsy, psychiatric disorders such as obsessive-compulsive disorder, brain tumors and neuropathic pain, Krishna said.

Dr. Ali Rezai, a neurosurgeon and director of the Neurological Institute at Ohio State, said that Wexner is the only Midwest hospital participating in the study. Ohio State, the University of Virginia and the University of Maryland plan to recruit a total of 20 patients.

“We’re thrilled about it,” he said. “This adds a whole new dimension in the way we can help people. We can perform brain surgery without ever cutting the skin.”

Nickelson said his symptoms started about 14 years ago. When he isn’t on his medication, he experiences a symptom called dystonia, which causes cramping and makes it difficult for him to move and articulate his thoughts.

“It feels like moving through the molasses,” he said. “Your brain is telling your arms and legs to move, and you can’t quite push through all this molasses.”

When he takes too much medication, he experiences dyskinesia, which he describes as jerking, flopping, twitching or shaking.

To avoid too much or too little, Nickelson must carefully keep track of time, sometimes taking his medication as often as every two hours. He also has to make sure he isn’t driving when a dose is about to wear off. Sometimes, it wears off at at the office, meaning he has to take work home with him.

He said he hopes this experimental treatment brings back a better home-work balance.

Despite some discomfort during the procedure, Nickelson said he likely will opt to go through it again to improve his right side. So far, he’s noticed improvement in his speech and other dystonia symptoms.

Nickelson knew about deep-brain stimulation, but didn’t want wires put in his brain or the hassle of maintaining the pacemaker-like device.

“I’ve been following the progress of focused ultrasound for several years,” he said the night before his surgery. “I’ve just been waiting for the chance to try it out.”


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