The Future of MR-guided Focused Ultrasound for Motor Symptoms of Parkinson's Disease

Essential Tremor MRgFUS

The focus of Parkinson’s disease (PD) treatment is relief from motor symptoms: the uncontrolled movements caused by the disease itself or the medications used to treat it. In 2019, MR-guided focused ultrasound became FDA-approved to treat tremor associated with Parkinson’s disease — a major breakthrough in PD motor symptom treatment.

Penn Medicine is currently the only medical center in the Delaware Valley performing this non-invasive technique. Now Penn doctors are conducting research to see if MR-guided focused ultrasound (focused ultrasound) can offer relief for other PD motor symptoms. We asked Gordon H. Baltuch, MD, PhD, Director of the Center for Functional and Restorative Neurosurgery to explain how focused ultrasound works and where he sees this technology being used in the future.

How do you describe focused ultrasound to your patients?

We describe it as focusing thousands of sound waves on a portion of your brain to make a small thermal lesion. We use a magnetic resonance (MR) machine to target precisely where we want to focus the sound waves and to measure the temperature in the brain.

Basically, it's like when you hold a magnifying glass in the sunshine and you focus it on a little piece of paper. This is the same thing, with sound waves instead of light waves, and it’s done in a very, very controlled fashion

What are some of the benefits of this focused ultrasound?

We've been using this therapy since 2016 for essential tremor. It's non-invasive, which is great. It can basically be done as a day surgery with a 23-hour stay. Overall, it has been terrifically successful.

In the last few months we've had FDA approval to treat tremor in patients who have Parkinson's disease. If they’re not getting the control that they would like with medical therapy, they might be candidates for this technique.

What other PD motor symptoms can be treated with focused ultrasound?

We have active research trials happening at Penn to see if focused ultrasound works for other motor symptoms of PD, including bradykinesia (slowness), stiffness and rigidity, dystonia (muscle contractions or cramping) and dyskinesia, which is uncontrolled movement that can occur as a side effect of a common PD medication.

Another PD symptom we’d like to treat is the poorly-controlled motor fluctuations that people experience when their medications work unpredictably. People with PD sometimes experience a roller coaster effect, bouncing between good symptom control and an “off state” that leaves them stiff and rigid.

Focused ultrasound is not yet an FDA-approved treatment for these symptoms, but participating in a clinical trial can help bring us closer.

Do you target the same parts of the brain for all of these PD symptoms?

For PD tremor, we're targeting the same part of the brain that we did in essential tremor. For the other symptoms, we're targeting a different target in the brain: the globus pallidus internus, which is in the basal ganglia.

What is the current treatment for these symptoms?

Deep brain stimulation, which is what we still do three times a week here. We've done about 1400 deep brain stimulation cases here, and it is currently the standard of care. However, focused ultrasound is a non-invasive alternative.

Are there potential complications of focused ultrasound?

We know from our work with essential tremor that people can have transient numbness or unsteadiness of the feet. It almost always goes away as the brain heals or as the swelling goes down.

What is the common recovery time?

It's a 23-hour stay. People often leave the morning after the procedure.

Are there any future applications for this therapy?

I think movement disorders are the main indications at the moment, but I suspect that the next thing that the medical community will look at will be epilepsy.

Request an Appointment

For more information about focused ultrasound for Parkinson's disease at Penn Medicine, please call 215-829-6700.

Enroll in a Clinical Trial for Parkinson’s Disease

Focused ultrasound is now being used in a clinical trial to treat non-tremor motor symptoms of Parkinson’s disease. To learn more about this clinical trial, please contact, Marie Kerr at 215-829-6720.

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