Thursday, February 9, 2023

A Voice You Can’t Hear But One Day May Change Your Life

(CNN) — Clinical trials are underway around the world for a brain surgery that doesn’t require incisions or cut off blood flow, but that dramatically improves the lives of people with essential tremor, depression and other problems . The procedure, known as focused ultrasound, directs sound waves to certain parts of the brain to disrupt faulty brain circuits that cause symptoms.

“Focused ultrasound is a non-invasive therapeutic technique,” says Dr. Neil Cassel, founder and president of the Focused Ultrasound Foundation. “We’ve said that focused ultrasound is the most powerful sound you’ll ever hear, but also a sound that could one day save your life.”

Cassell describes his operation as “analogous to focusing a light beam on a point and using a magnifying glass to poke holes in a sheet”.

“With focused ultrasound, instead of using an optical lens to focus light beams,” he says, “an acoustic lens is used to focus multiple beams of ultrasonic energy on the body with a high degree of precision and accuracy.” This is done to focus on the target deep within, preserving the adjacent normal tissue.

The procedure has proven highly beneficial for people with essential tremor, a neurological disorder that causes involuntary, rhythmic tremors. The disorder can affect almost any part of the body, but tremors often occur in the hands, even during simple tasks such as eating, drinking or writing.

Essential tremor is often more prominent on one side of the body and may worsen with movement. According to a 2021 study, it is most common in people age 40 and older, affecting about 25 million worldwide.

Such was the case for Brenda Harik, 80, who recently underwent focused ultrasound at the University of Virginia, the institution that pioneered the procedure.

She told CNN that Harik’s tremors made her uncomfortable in social situations because she was afraid of spilling or knocking over something.

But with just 44 seconds of focused ultrasound waves, the tremors were gone.

“I looked at my hand and saw it wasn’t moving, it was the first time in 20 years I could see my fingers move,” Harik said. “I think it’s definitely a miracle, and I thank God for that.”

How does this work

Focused ultrasound is a form of functional neurosurgery, that is, intervening in structures deep in the brain to modify them, restore their function, or in this case to stop tumors. According to experts, it is an alternative treatment for people, like Echrich, who do not respond or are not affected by conventional drug treatments.

“In a simple sense, you can imagine that there is a bunch of abnormal neurons on this single target that are going out of control, causing tremors, tremors,” Kassel said.

Focused ultrasound technology uses a transducer to force a beam of sound waves to converge on a single point to raise the temperature and destroy tissue.

Before receiving high-intensity focused ultrasound, which is necessary to treat essential tremor, patients should have their heads shaved, as air can sometimes become trapped in the hair follicles.

The patient then undergoes MRI and CT scans so doctors can use the resulting images to map the brain’s structure and target.

In the image, images of Harik’s brain. Focused ultrasound significantly improved this 80-year-old’s tremor. (CNN)

Insightec Exablate Neuro, a focused ultrasound platform, pinpoints how many beams to use to perform a treatment, and then neurosurgeons can do what Dr. Jeff Elias calls “test shots,” just to be sure That we are focused on the right target. precise point”.

Elias, the UVA Health neurosurgeon who treated Ehrich, is a pioneer in the treatment of essential tremor using ultrasonic waves. In 2011, he led pivotal clinical trials in the United States to obtain regulatory approval for this procedure.

“These (test shots) are really low energy, but we want to see if our treatment is exactly where we want it,” he said. “This is our chance to aim the rifle.”

Four 11-second treatment doses significantly improved Echrich’s tremor. The entire process took less than two hours, most of which was spent mapping the brain and testing the target.

Before, Hric had trouble drawing inside the lines of the circles. Focused ultrasound helped them color within the lines.

advantages and disadvantages

Anyone with a diagnosis of essential tremor that doesn’t respond to medication usually needs to undergo a focused ultrasound treatment, according to Dr. Nir Lipsman, a scientist at Toronto’s Sunnybrook Health Sciences Center and director of Sunnybrook’s Harquall Center for Neuromodulation. Could

According to Dr. Noah Philip, professor of psychiatry and human behavior at Alpert University School of Medicine Brown, people who cannot get an MRI because of claustrophobia or metal inside their bodies are not eligible for focused ultrasound. Philip also directs mental health research at the Veterans Administration’s Center for Neurorestoration and Neurotechnology.

Ideally, according to Lipsman, the benefits of focused ultrasound should be permanent. “If the part of the brain responsible for tremors can be destroyed, the effects should be permanent,” he says. “Up to a year, however, some of these patients will have a rebound or recurrence of their tremor, and we don’t know why.”

However, this withdrawal can occur even with drug treatment, which is why some patients with essential tremor resort to focused ultrasound.

But according to a 2022 study by Elias, some patients have experienced benefits up to five years after undergoing focused ultrasound.

The mapping and testing portions of the procedure are so important because of the potential side effects of focused ultrasound. If the wrong area is targeted or over-treated, the patient’s balance and stability may deteriorate in the long term.

“The most common risk we find in patients is temporary numbness or tingling that can sometimes occur in the area of ​​the treated arm or lip,” explains Lipsman. “The vast majority of the time that goes away with time.”

Another frequent risk, but usually temporary, is slight instability in the legs after the intervention. But doctors do not use general anesthesia or hospitalize patients for this procedure.

future in this field

Today, focused ultrasound technology is used around the world in various phases, including clinical trials and approved regulatory uses. According to Castle, there are more than 170 clinical applications — including neurodegenerative disorders and brain, breast, lung and prostate tumors — and the field is growing.

“You can see the effect of an ultrasound treatment in real time as it is being delivered, whereas the effect of a treatment with radiation is invisible while it is being delivered,” Kassel explains. “And it takes weeks or months for the effects of radiation to become apparent.”

Its use for depression and obsessive-compulsive disorder is on the table, according to a small 2020 study by Lipsman and a team of researchers. Scientists found that focused ultrasound was safe and effective at improving symptoms in people with major depression and obsessive-compulsive disorder. But more study is needed.

According to Lipsman, one limitation of focused ultrasound is that not everyone’s skull is the same.

“The density of the skull greatly affects the ability of ultrasound to pass through it,” he said. “It’s rare, but there are some patients who, no matter how hard we try, we can’t wound the brain effectively. The skull doesn’t allow ultrasound through. It’s a technical limitation of the technique, some One where we are actively engaged.”

Focused ultrasound isn’t available for all conditions, but experts are hopeful that “medicine’s best-kept secret” will one day become standard treatment.

“I think that within 10 years,” Kassel says, “focused ultrasound will be a mainstream therapy affecting millions of patients worldwide every year. It will be widely accepted.”

CNN’s Adeline Chen contributed to this article.

Nation World News Desk
Nation World News Desk
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