Focused Ultrasound Helps Eliminate Essential Tremor

Prior to February 2021, Rich Schaefer of Blue Springs couldn’t legibly sign his name. He couldn’t get a forkful of food into his mouth without tremendous effort. It took him 10 minutes to button his shirt. Today, however, life is much easier.

Rich was diagnosed with essential tremor about 6 years ago. The condition, which is often genetic and affects about 10 million Americans, causes shaking, usually in the hands and arms and sometimes in the head, voice and legs. While it is often confused with the tremors associated with Parkinson’s disease, essential tremor can occur at any time throughout the lifespan, but is most commonly diagnosed in people over 40 years of age. It tends to occur on both sides of the body, and worsens with movement, as opposed to Parkinson’s disease tremors that tend to start on 1 side of the body and are more prominent when the hands are at rest.

Norma Schaefer married Rich 5 years ago, and his tremor was already noticeable when the couple met, she says. In addition to the practical challenges of daily living, the condition caused embarrassment and made Rich reluctant to participate in social activities. “He was struggling, and he was so ashamed of the way he shook,” Norma says. “It would take 2 hands just to hold a cup of coffee. He didn’t want to go out to eat. He didn’t want to have people over. He was just very, very self-conscious.”

The first line of treatment for most people with essential tremor involves medication. Physicians may prescribe beta blockers (typically used to treat high blood pressure but also effective for tremor in some people), antiseizure medications or antianxiety medications, but the medications are not effective in all patients and may lead to intolerable side effects.

In recent years, neurologists began using a new, more invasive, yet much more effective treatment: deep brain stimulation. The procedure involves a neurosurgeon implanting a wire into the brain, which then runs through the neck and connects to a battery pack in the chest. A few weeks after surgery, physicians and specially trained staff adjust the wire’s voltage, frequency and wavelength, stimulating the brain to communicate effectively with the muscles. For many people, the result is nothing short of miraculous.

Now, however, physicians at The University of Kansas Health System have an additional option among the existing array of treatments for essential tremor and tremor-dominant Parkinson’s disease. For Rich Schaefer it made a world of difference in just a couple of hours.

Michael Kinsman, MD, a neurosurgeon at The University of Kansas Health System, treated Rich with focused ultrasound (Exablate Neuro), a neurosurgery platform that uses focused ultrasound to penetrate the skull and treat the brain with no incisions. Using heat created by the focused sound waves, the treatment destroys tissue in a specific area of the brain, reducing the tremor. Dr. Kinsman uses magnetic resonance imaging (MRI) to target the exact treatment location and deliver the ultrasound precisely without damaging surrounding brain tissue.

The benefits of focused ultrasound include no need for anesthesia, no hardware implanted in the body, rapid improvement of symptoms and no radiation exposure. FDA-approved since 2016, focused ultrasound is an option for people whose symptoms no longer respond to medication. The University of Kansas Health System is the only provider in the region offering focused ultrasound for essential tremor and Parkinson’s disease tremor.

When first presented with the focused ultrasound option, Rich wasn’t sure about having his brain tampered with, Norma muses. But it didn’t take long for him to come around. Just before the procedure he said, “My family is like me – a little nervous but eager for this to happen.”

On February 23, 2021, it did happen. Instead of using surgical instruments in an operating room, Dr. Kinsman positioned Rich on a table fitted with a helmet-shaped device for his head. After sliding helmet-clad Rich into an MRI machine, Dr. Kinsman viewed real-time MRI images of Rich’s brain and used a computer mouse to target and deliver the ultrasound to a tiny but crucial brain region.

Prior to the procedure Rich wrote his name – a scrawl of jagged strokes that were largely indecipherable, beginning with a recognizable R and trailing into a jumble. Just 90 minutes later, having been in and out of the procedure room, Rich tried again. The letters were clear from the first character to the last.

Rich and Norma both praise the staff at The University of Kansas Health System and look forward to a future not focused on tremor. “I think it’s just amazing what can be done with technology nowadays,” Norma says. “Dr. Kinsman was very thorough and very good. The communication is great here,” Rich notes. “I trust the health system 100%.”