In 2018, scientists at the University of Utah developed a safer method for treating Parkinson’s disease. It is a non-surgical sound ablation of problematic areas of the brain. This method is FDA approved and allows patients to get rid of tremor with less risk of side effects.
You can learn more about how MRI-HIFU works, its advantages, disadvantages, and which clinics offer the treatment from this article.
How does MRI-HIFU work in treating Parkinson’s disease?
MRI-HIFU (Magnetic Resonance Imaging and High-Intensity Focused Ultrasound Therapy) is the most modern and safe method of treatment for Parkinson’s disease. It uses intensive ultrasound to burn out the areas of the brain responsible for the tremor that is characteristic of Parkinson’s disease. The advantage of this method is that you do not need to perform brain surgery or use anaesthesia. The patient undergoes the procedure in full consciousness and can notice a decrease in tremor immediately after the surgery.
Ultrasound ablation (HIFU) has been used in medicine since 2004. It has significant advantages over conservative treatment options. However, until 2016, it was not used to treat brain diseases. The problem was the accuracy of the ultrasound beam. In case of an error, the surgeon could damage important brain centres and cause long-term complications for the patient, such as sensory and gait disturbances.
The technical capabilities of the 2000s did not allow for the exact location of the pea-sized nucleus, which is of interest to the neurosurgeons. MRI scanners were not able to visualize such a small zone. Without the capabilities of modern equipment, doctors could make mistakes of up to 5mm, which is critical in these circumstances.
Previous methods of surgical treatment of Parkinson’s disease caused serious side effects in 15-20% of patients.
Parkinson’s disease
Parkinson’s disease (PD) is a neurological disorder that affects 7-10 million people worldwide. Its main symptoms are tremor of the limbs, movement disorders, speech and writing difficulty. PD is caused by a disturbance of a substance called dopamine in the brain. People over 50 years of age are most likely to suffer from this disorder.
Improvements in imaging techniques such as MRI, have allowed physicians to bypass those limitations. In 2018, scientists at the American University of Utah developed a method combining MRI scanning and ultrasound ablation. It can be used to localize and irradiate the needed part of the brain – one of the thalamus nuclei – in live time mode.
How is MRI-HIFU performed?
Diagnostic scanning of the patient’s brain. Collection and analysis of information. Treatment planning.
Real-time monitoring of the patient’s brain. Biofeedback method.
High-intensity ultrasonic ablation (burning out) of the part of the brain that creates tremor.
Tremor reduction, noticeable immediately after treatment.
MRI-HIFU has been actively used in treating Parkinson’s disease since 2019, and the results are encouraging. In one study, 6 months after treatment, no side effects were found in any of the subjects.
The FDA has approved three subtypes of MRI-HIFU therapy to treat Parkinson’s disease and other forms of essential tremor. They differ in the way they visualize the required part of the brain.
FGATIR method
The FGATIR method is based on the creation of contrasting MRI images, where the white matter of the brain is coloured in dark tones and grey matter – in light. With this imaging, the right thalamus core stands out vividly from the surrounding tissue.
Diffusion Tractography
Diffusion Tractography uses water metabolism analysis in the brain. Water molecules dissolve in cells at different speeds, depending on the type of tissue. With this information, doctors can build a 3D model of the white matter in the brain and accurately localize the nucleus.
This method is the most researched and promising. With its help, it is possible to create images with very high resolution and accuracy.
Quantitative Sensitivity Mapping (QSM)
The QSM method allows doctors to detect the area of the brain by observing substances such as blood or iron. They actively interact with the magnetic field used in this diagnostic procedure and interfere with the image. With the help of special software, it is possible to localize the necessary parts of the brain based on the analysis of these interferences.
QSM allows detecting the required thalamus nucleus with an accuracy of 0.9 mm.
All three methods are more accurate and reliable than a conventional MRI. However, they have several drawbacks. They can only be performed on more advanced CT scans, at least 3T MRI. They require a longer and more thorough diagnosis of the patient as well as the higher expertise of the physician.
Side effects of MRI-HIFU treatment for Parkinson’s disease
The HIFU method of treatment of neurological diseases is precise and gives quick observable results, but also often causes side effects. This is because the structure of the brain is complex and sensitive to external influences. However, these effects are short-lived and most of them go away on their own after 1-6 months.
Most common side effects of MRI-HIFU:
Sensory abnormalities in mouth and hands;
Feeling a slight tingling sensation and “shivers”;
Ataxia (disturbance of motion consistency);
Balance disturbances.
How else do you treat Parkinson’s?
Before the invention of the MRI-HIFU method, Parkinson’s disease was treated primarily by medication and surgery. Even today, they are used in clinics specializing in the treatment of neurological diseases.
Medical treatment for Parkinson’s disease
When diagnosed with Parkinson’s disease, the first treatment prescribed by doctors is medication. It’s the safest, most accessible and the cheapest method. The medication affects the level of dopamine in the brain. Usually, they are well tolerated by patients and side effects are controlled.
However, 30% of patients with Parkinson’s disease are not medically treatable. To help them, doctors are using more invasive interventions.
Thalamotomy
The operation is very similar to the MRI-HIFU method. To reduce tremor, the doctor damages the necessary thalamus nucleus. Previously, this procedure was done only in the form of open surgery. Modern physicians prefer to use non-invasive methods such as radiofrequency, ultrasonic ablation or Cyberknife.
DBS
Deep brain stimulation is another modern method of treating Parkinson’s disease. The doctor puts a small pacemaker-like device under the skin. It delivers electrical impulses to the brain that block or alters abnormal activity that causes symptoms.
It’s a safer method than thalamotomy, but it still requires surgery.
Advantages of MRI-HIFU in comparison with other treatment methods
Thalamotomy | MRI-HIFU | Medicines | DBS |
---|---|---|---|
High risk of long-term consequences | Low risk of long-term effects | Low risk of long-term effects | Low risk of long-term effects |
Side effects may remain after 12 months | Side effects last for 6 months | Side effects can be controlled with additional treatment | Side effects can be eliminated by changing the device settings |
Requires surgery | Does not require surgery | Does not require surgery | Requires surgery |
Helps patients after unsuccessful medication treatment | Helps patients after unsuccessful medication treatment | Efficiency in 60% of cases | Helps patients after unsuccessful medication treatment |
From $13,800 (Turkey) | From $16,000 (Turkey) | About $200/month (Turkey) | From $30,000 (Turkey) |
Clinics that specialize in the treatment of Parkinson’s disease
Rambam Clinic (Israel);
Teknon Clinic (Spain);
University Clinic of Navarra (Spain);
Helios Medical Centre (Germany);
Ludwig-Maximilian Hospital (Germany);
Liv Clinic (Turkey);
A network of Medical Park Clinics (Turkey).
Resume
MRI-HIFU is a modern method of treatment of severe forms of drug-resistant Parkinson’s disease. It consists of burning one of thalamus nuclei, which causes tremor, with ultrasound.
The FDA has approved three MRI-HIFU treatments for essential tremor. They are based on an in-depth study of the brain and finding the right area with 0.9 mm precision.
MRI-HIFU treatment for Parkinson’s disease is safer than surgery and cheaper than deep brain stimulation (DBS).
The result after MRI-HIFU treatment is visible immediately after the procedure. Possible side effects will disappear by themselves within the next 6 months.
MRI-HIFU treatment of Parkinson’s disease can be done in TOP neurosurgical centres of Israel, Spain, Germany and Turkey.
Stay with MediGlobus and keep up to date with the latest news on the latest developments in foreign medicine. If you need help from a neurologist abroad – leave an appointment. Our coordinators will help you find a clinic that offers a treatment program that will help you.
Источники:
Comments