The University of Virginia is leading the first effort to use noninvasive focused ultrasound to treat symptoms of Parkinson’s disease.
Since 2011, UVa has been a center for research in focused ultrasound, the use of high-intensity sound energy to destroy damaged or diseased tissue. It has proved safe and effective for patients with essential tremor, officials said, providing an alternative to risky brain surgery.
Now researchers say they’re confident it could help treat a range of symptoms in Parkinson’s patients sometimes known as dyskinesia, including tremors and involuntary movements.
“Everybody wants a cure for Parkinson’s, but for the time being, this could be a big breakthrough in symptom management,” said Dr. W. Jeffrey Elias, who has headed several major studies in focused ultrasound.
UVa is collaborating with the University of Maryland — along with centers in Canada and South Korea — to test the effectiveness of the treatment on dozens of patients. Earlier this summer, UVa conducted the first focused ultrasound session on a Parkinson’s patient in the U.S.
Researchers at the University of Maryland conducted another trial one week later, said Dr. Howard M. Eisenberg, chair of the university’s department of neurosurgery.
Patients in the trials will go through several sessions between now and next year, Elias said. Typically, the patients are subjected to focused ultrasound beams for about 10 to 15 seconds at a time. The treatment is essentially painless, though patients have reported discomfort during long sessions.
The point is to interrupt an “abnormal circuit” that forms in Parkinson’s patients, Elias said. Doctors do this by directing more than 1,000 beams of sound deep inside the skull to a part of the brain smaller than a grain of rice.
“We’re able to do the type of treatment that would usually require making a hole in the head and inserting a probe,” Elias said. “We’re able to do this without making an incision in the head.”
Interrupting these abnormal circuits can relieve rigidity and tremors in patients, Eisenberg said.
“When you have Parkinson’s, some cells in the brain degenerate — that is one of the major pathologies,” he said. “If you perturb the system, you can relieve some of those symptoms.”
The focused ultrasound procedure produces nearly the same results as the invasive brain surgery used on patients until the late 1960s. After that era, doctors began using the drug levodopa — L-dopa for short — to treat symptoms. L-dopa has allowed doctors to treat symptoms without surgery since then, but patients often reach a “ceiling,” Elias said. The longer they take it, the less effective it becomes.
When the drug has become completely ineffective, doctors sometimes resort to deep brain stimulation, a risky surgical procedure that involves implanting electrodes into the brain. When the batteries powering the device run out, patients could need another procedure.
“Over the years, it became clear patients needed more L-dopa as time went on and there were side effects,” Eisenberg said. “The possible place of focused ultrasound is to be another step. … This could replace [deep brain stimulation].”
Like anything else, the ultrasound treatment carries risks, Elias said, including “neurological events” such as a stroke or a hemorrhage. But researchers believe the risk should be significantly lower than the risk associated with deep brain stimulation, he said.
“We’re in the process of figuring out what is the perfect amount of treatment to balance the risk of side effects with the durability of the treatment,” Elias said.
The study, funded by a partnership between the Focused Ultrasound Foundation and The Michael J. Fox Foundation for Parkinson’s Research, is still searching for volunteers. Patients whose medication has failed to satisfactorily control dyskinesia are eligible.
Anyone interested in the trials can contact the Focused Ultrasound Foundation at (434) 220-4993.