- Researchers say a targeted ultrasound treatment has shown promise in reducing symptoms associated with Parkinson’s disease.
- They said participants in a study who received the treatment showed improvement in mobility as well as a reduction in tremors.
- Experts note that other treatments for Parkinson’s include deep brain stimulation, medications, and lifestyle factors such as diet and exercise.
Targeted ultrasound might help reduce tremors, mobility issues, and other physical symptoms associated with Parkinson’s disease, according to a recent study published in the New England Journal of Medicine.
Researchers at the University of Maryland School of Medicine worked with 94 people previously diagnosed with Parkinson’s disease.
The scientists randomly assigned participants to one of two groups. They received either:
- A focused ultrasound to ablate a targeted region on one side of the brain.
- An inactive procedure that offered no medical benefit.
Researchers reported that about 70% of the treatment group had positive outcomes three months after the procedure compared with 32% in the control group.
They added that two-thirds of those with positive results experienced a successful response one year after receiving the ultrasound treatment.
How ultrasound treatment helped Parkinson’s symptoms
Researchers said study participants who received ultrasound treatment experienced immediate improvement on at least three points on a standard assessment – measuring tremors, walking ability, and rigidity in the legs and arms.
They also had relief from dyskinesia, a common side effect of medications for Parkinson’s disease.
Side effects from the procedure included headache, dizziness, and nausea that typically disappeared one to two days after treatment. Some participants experienced slurred speech, walking issues, and loss of taste, but these disappeared within a few weeks.
“It is a minimally invasive neurosurgery,” said Dr. Rebecca Lalchan, DO, a neurologist and movement disorder specialist at NYU Langone Hospital – Brooklyn who was not part of the study. “It uses high-frequency ultrasound using real-time MRI guidance to gradually deliver heat to a part of the brain involved in Parkinson’s disease. It creates a permanent lesion that disrupts signaling and improves movement in patients with Parkinson’s disease.”
Experts did say further studies and follow-ups are needed to determine how long the benefit lasts.
“It is unclear how long the benefits could last after completion of the treatment, said Dr. Jean-Philippe Langevin, a neurosurgeon and director of the Restorative Neurosurgery and Deep Brain Stimulation Program for Pacific Neuroscience Institute at Providence Saint John’s Health Center in California.
“This is a new way of treating Parkinson’s disease, so it is not entirely clear if the patients continue to benefit from the procedure several years after completion. This data is being accumulated currently,” he told Healthline.
Parkinson’s disease treatments
There isn’t a cure for Parkinson’s disease nor a treatment that can slow or stop the disease.
Doctors tailor therapy to an individual’s symptoms and some options can help:
Treatment is complicated because medications used to treat the symptoms can also cause them.
“Dyskinesia can be caused by some of the most common drugs used to treat Parkinson’s disease, such as Levodopa,” Langevin told Healthline. “To treat dyskinesia, the patient’s doctor will have to understand the relationship and timing to medication dosage. In cases where dyskinesia is a side effect of the medication, traditional strategies to solve the problem include reducing the medication dosage and using other medications to cover the symptoms of Parkinson’s.”
The most commonly prescribed drug is levodopa, which increases the amount of dopamine in the brain, according to the National Institute on Aging.
Carbidopa or amantadine is typically prescribed alongside levodopa to help with side effects, such as nausea, vomiting, low blood pressure, and restlessness.
Depending on a person’s symptoms, other medications such as dopamine agonists, enzyme inhibitors, amantadine, and anticholinergic drugs can be used.
Dopamine is a crucial factor in Parkinson’s disease.
“Not enough dopamine and we see slow and stiff movements, loss of facial expressions, decreased arm swinging, constipation, soft speech, and eventual a tremor that appears only while not moving,” said Dr. Brian Dalm, a neurosurgeon specializing in pain and functional neurosurgical disorders at The Ohio State University Comprehensive Cancer Center. “Too much dopamine and we can see excessive movements that we call dyskinesias.”
Deep brain stimulation is done via a surgical procedure where wires are Implanted in the brain and connected to an electrical device in the chest. Electrical currents are sent to stimulate areas of the brain responsible for movements. It can help stop some symptoms, such as tremors, slow movement, and rigidity.
Before the procedure, patients are evaluated.
“Typically, the patients should have a thorough assessment by a movement disorder neurologist to confirm candidacy,” Langevin said. “Additional tests that could be useful include a pre-operative MRI of the brain and a neuropsychological evaluation.”
Lifestyle therapies can also help.
These include exercise, a healthy diet, massage therapy, yoga, and tai chi.
How and when to use ultrasound treatments
Federal regulators have approved the ultrasound treatment for Parkinson’s for one side of the head.
There’s a reason.
“One side is always more affected than the other,” said Dr. Alessandro Di Rocco, a neurologist at Lennox Hill Hospital in New York. “This is a precision procedure and being off only by a few millimeters can cause damage in other areas of the brain and result in problems such as loss of sensation or cognitive issues.”
“Interestingly, even though you are only working on one side of the brain, you might see generalized improvement rather than only seeing it on one side,” he told Healthline.
Although targeted ultrasound is a new treatment for Parkinson’s, Di Rocco expects it to be a long-term solution.
“It is important to note that this is an advanced treatment,” he explained. “This is not meant to treat early Parkinson’s disease and is not a cure. Targeted ultrasound can be considered when other treatments, such as medications and lifestyle therapies, no longer work.”
People who previously had a stroke or brain damage are probably not good candidates for the procedure. Those who have a thick skull won’t receive the full benefit.
“A cat scan of the brain to assess skull density done before the ultrasound can show the thickness and density,” said Lalchan.
In the study, the Exablate Neuro device provided targeted ultrasound energy to the globus pallidus, a structure deep within the brain. MRI images helped the medical professional target the area and apply a high enough temperature to ablate it.
“This is considered a stereotactic neurosurgical procedure,” Dalm told Healthline. “The procedure starts with the placement of a stereotactic head frame. Once it is in place, a series of MRI images are obtained to ‘align’ the targeting of the ultrasound waves to ensure the shape and location of the lesion. After this portion is complete, the energy delivered is then increased to perform a test lesion to check for symptom improvement and to check for any possible side effects. No actual ablation of brain tissue has occurred at this time so any symptom improvement or side effects if seen are not permanent.”
“If things look good, then the energy delivered is increased to heat the brain tissue to a temperature that will create a permanent ablation,” Dalm added. “It is performed without sedation so the surgeon can monitor for any unwanted side effects. Generally, several permanent ablation treatments are performed to ensure adequate volume size to give the best possible treatment outcome. It is important to note that there are several factors that play into whether an ablation will be successful.”
Parkinson's and Ultrasound: How Targeted Treatments May Help Reduce Symptoms
Source: Pinoy Lang Sakalam
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