If you’ve ever watched an interview with a celebrity or spokesperson with Parkinson’s disease, you may see some twitching or jerking. Often, those movements aren’t due to the Parkinson’s — they’re actually a side effect of medication.
While there is no cure for Parkinson’s disease, many patients find relief from some of the worst symptoms, such as rigid muscles, with prescription medication. They can help patients improve speed and coordination, and lessen tremors.
Unfortunately, these medications sometimes have challenging side effects. One of the main side effects of medication for Parkinson’s is involuntary, unusual movements (dyskinesia). While these movements may be easier to manage than major symptoms of Parkinson’s, they can still be very frustrating. And what’s even more frustrating is that there are limited treatments available to combat this side effect.
That’s why Penn Medicine is part of a national study to find a way to improve dyskinesia in patients taking medication for Parkinson’s disease. The clinical trial uses a special technology called MRI-guided focused ultrasound to help patients manage the involuntary movements that come with Parkinson’s medication.
Since our clinical trial is for patients with advanced Parkinson’s, we work hand-in-hand with both patients and their caregivers.
Gordon Baltuch, MD, Director of the Center for Functional and Restorative Neurosurgery at Penn, is leading the research team working on the Focused Ultrasound clinical trial.
Q: What are traditional types of treatment for this side effect of Parkinson’s Disease medication?
Dr. Baltuch: We currently use deep brain stimulation (DBS). DBS is an open brain surgery where we insert two wire electrodes deep into the brain to reach the structures that cause the involuntary movements.
Then, we implant a small impulse generator battery — sort of like a pacemaker — into the chest. The generator sends an electrical impulse to the part of the brain that controls movement. You will get a controller to turn the device on and off. DBS is very successful. Our Parkinson’s Disease and Movement Disorders Center is one of the largest centers of its kind in the country, and we have performed more than 1,200 procedures, helping patients tremendously. However, it is an open surgery, which does carry risks, such as blood clots or serious infections. Focused Ultrasound, on the other hand, is non-invasive.
Q: What exactly is Focused ultrasound?
Dr. Baltuch: Focused ultrasound is a non-invasive, non-surgical procedure. We use focused ultrasonic waves to create a distinct thermal lesion deep in the brain without injuring surrounding structures. During the procedure, we use a magnetic radiofrequency imaging (MRI) thermal imaging system. This measures temperature changes in the skull, and helps us make sure we’re keeping the patient safe.
It’s a great procedure because we can work on very delicate areas safely and effectively, with very few side effects.
Q: How do you explain what this clinical trial is looking at?
Dr. Baltuch: We’re looking at using focused ultrasound as a way to treat involuntary, unusual movements. If you’ve ever watched an interview with a celebrity or spokesperson with Parkinson’s, you may see some twitching or jerking. Often, those movements aren’t due to the Parkinson’s — they’re actually a side effect of medication. That’s what we’re hoping to treat with focused ultrasound.
In order to do this, we are specifically targeting the basal ganglia. This is a group of structures in the brain that are involved with movement control and coordination.
To learn more about Focused Ultrasound please read: Focused Ultrasound
Q: What are the benefits of a non-invasive procedure like focused ultrasound?
Dr. Baltuch: There are several reasons why we try to do non-invasive procedures when possible. We don’t have to make any large cuts or put anything directly into the brain. We’re not drilling holes, and there’s no hardware.
Non-invasive procedures are also great for people who can’t get open surgery. They may be a high-risk patient — for example, someone who is obese, which increases the risk of complications during surgery. Or, they may be nervous about the concept of surgery directly on the brain.
Q: Sounds great, but are there any risks?
Dr. Baltuch: Just because focused ultrasound is not invasive doesn’t mean it comes without risks. We’re still creating a thermal lesion in the brain. If we make it too big, it could cause slurring of words or balance issues. Also, we’re targeting a specific area of the brain, that is just above the track that leads to the visual cortex. If we hit this track, we could cause vision problems.
We try to predict everything that could come up during a trial beforehand. But every single trial is investigative — we are focusing on discovering new things. And because of this, there will always the unforeseen.
When joining a clinical trial, always expect the unforeseen. If you expect that you will never be blindsided, that’s where you will get yourself in trouble. Life isn’t like that, and clinical trials certainly are not. But also know that everyone on the clinical trial team is aware of that — and we are prepared to deal with unforeseens when they happen.
Q: What does this clinical trial mean for the future of movement disorders and Penn Neurosurgery?
Dr. Baltuch: This research can definitely be a stepping stone. We’re targeting just one symptom of Parkinson’s medications right now. If it’s successful, we could use other targets to control other symptoms — from Parkinson’s itself, or medications — such as stiffness or tremor.
Q: Who is a good candidate for this clinical trial?
Dr. Baltuch: We welcome calls from any interested patient. We’re looking for patients who have advanced Parkinson’s and who have unusual, involuntary movements due to a Parkinson’s medication. As long as someone meets these criteria, we’ll consider patients of any age, ethnicity, or gender.
Ability to pay does not make a difference — since this is a fully-funded study, we cover the costs of all procedures and follow-up care.This study is actually part of a larger study. Institutions from across the country, as well as a few in Canada and England, are performing similar clinical trials.
We are beginning this trial at the end of the 2018 summer, and are hoping to perform one procedure a month for a year.
Q: Who is on the clinical trial team?
When you join a clinical trial at Penn, you will always have a great support team.
If you participate in the focused ultrasound clinical trial, you will be working with many different specialists. You will work with a neurologist, psychiatrist, ophthalmologist, nurse practitioner — it’s a huge group of people who bring this all together. It’s an enormous team effort from top to bottom, from the clinicians to the administrative staff.
If you are interested in learning more about this clinical trial, please contact: Marie Kerr: 215-829-6720.