Parkinson’s disease, ultrasound against the tremor of the disease – breaking latest news

A new treatment, called MRgFUS, which stands for Magnetic Resonance guided Focused UltraSoundcio Magnetic resonance-guided focused ultrasoundcan free from tremor who suffers from it even for years. The prestigious reports New England Journal of Medicine in a study just published by North American and European centers, including the Carlo Besta Neurological Institute in Milan. We started using this technique in 2019 for parkinsonian tremor and we have now exceeded 140 cases, with results that patients define as touching —say the neurologist Roberto Eleopra and the neurosurgeon Francesco Di Meco, who manage the treatment at the Milanese institute— L The enthusiasm of the healed is such that sometimes we have to invite them not to change their lifestyle by getting overwhelmed by euphoria.
The American initials of the FUSA machine. acronym of Focused UltraSound Ablation, i.e ablation by focused ultrasound, where the term ablation encloses the principle of this instrument, i.e. the concept of taking away, subtracting, from the Latin ablationis. They had already tried ablation in the 1950s and even with a certain effectiveness, but at the price of onerous neurosurgical operations which, while improving the Parkinsonleft heavy postoperative aftermaths in patients.

Pale globe

As the neurosurgeon Andres Lozano of the University of Toronto, Canadian referent for this latest study on MRgFUS, recounts in the journal Neurosurgery, it was understood that by injuring some areas of a region located in the center of the brain called pale globe trembling and other symptoms of Parkinson’s disease could be stopped because the impulses that caused them were coming from there. born like that pallidotomyfrom the Greek tmno that is to cut, for which the buccal part of the pale was surgically cut.

Levodopa and deep brain stimulation

In the 60s, with the advent of levodopa, the protagonist drug of the well-known film You awaken with Robert De Niro where patients blocked for years start moving again, within a decade every operation on the pale globe ceased because a simple tablet was much more comfortable, but in the 90s, due to the limitations that emerged with the time of levodopa, interest in pallidotomy was rekindled. There was no return to lesional neurosurgery of the pale, but a compromise was found, that is to keep it at bay with electric micro-pulses. In 1987, the neurosurgeon Alim Benabid of the University of Grenoble developed the so-called Dbs, an acronym for deep brain stimulationcio deep brain stimulation, based on the intracerebral positioning of a micro-generator of impulses which calmed the hyperactivity of the globus pallidus or of other cerebral structures which are reached by micro-filaments on which the micro-impulses of the generator travel. There Dbs has revolutionized the treatment of this and other diseases so much that it has never been abandoned and indeed improved by evolving into adaptive DBS which increases or decreases impulses when necessary for ever greater effectiveness. But even DBS, albeit to a lesser extent than the old pallidotomy, requires invasive surgery for the positioning of the generator and micro-wires, as well as continuous maintenance, even just to change the battery from time to time, positioned under the skin in the chest.

Non-invasive revolution

MRgFUS subverts the approach to movement disorders, of which Parkinson’s is only the most representative example. Without any incision or hole in the skull, but only with a stereotaxic helmet that can resemble the one for the perm, ultrasound beams are collimated with millimeter precision — explain Eleopra and Di Meco — Their convergence causes a thermal effect (+60-70) burning the brain area perfectly selected by MRI. The treatment itself lasts a few seconds and requires a single 2-hour session due mostly to the preparation of the patient who is always awake. Then she gets up from the couch no longer shaking and if anything with a little headache and dizziness that pass quickly. In no more than 15% of cases there may be relapses within a maximum of one year of the first treatment – adds Di Meco – but the procedure can be repeated without problems, returning the patient to the newfound normality.

Beyond the tremor

Using focused ultrasound at a lower frequency, it is possible to transform MRgFUS into an unsuspected ally in the treatment of brain tumors. The Besta Institute was the first center in Europe to do so while in North America there is already a record of about twenty cases for glioblastomi primary or secondary and the use is also being studied in brain metastases. We are not yet thinking of targeting the ultrasound beams on the neoplastic formations – explains Di Meco – but only of solving an age-old problem of their treatment. In fact, chemo- and immuno-therapies manage to reach them only in part because they are blocked by the blood-brain barrier, that sort of film that covers and isolates the brain to defend it from toxic and infectious agents circulating in the rest of the body. With focused ultrasound we can open transient micro-gaps in the barrier, just long enough for drugs to cross it and obtain those effects that we have never been able to have until now. A treatment of this type requires at least 5 or 6 specialists in the operating room who will work side by side with the neurosurgeons in coordinating the combined MRgFUS/chemotherapy treatment. And this teamwork, after all, the future not only of neurosurgery of brain tumors, but of all medicine.