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Focused Ultrasound for Essential Tremor: The Future of Neurosurgery at Penn


Gordon H. Baltuch, MD, PhD, Director of the Penn Center for Functional and Restorative Neurosurgery, is at the vanguard of Essential Tremor (ET) therapy using Focused Ultrasound as an alternative to traditional surgery.

Essential tremor is a movement disorder that affects approximately 10 million individuals in the United States. Medication is typically the first line therapy for ET. However, some patients do not respond to these agents. Previously, patients who did not respond to first-line medications would have been candidates for Deep Brain Stimulation or thoracotomy surgery.

Focused Ultrasound is MR-guided, and a revolutionary new approach in the field of neurosurgery for the treatment of ET that offers these refractory patients a noninvasive alternative to surgery – completely avoiding the need for incisions and craniotomy.  

In a new ReachMD interview, Dr. Baltuch discussed how therapies have evolved over time. The greatest advantage of Focused Ultrasound is that it does not require incisions, and avoids the associated risks that come with invasive approaches to ET therapy. “Focused Ultrasound doesn’t involve any hardware and, in some circumstances, can be done as an outpatient procedure,” he continued. “What’s really exciting is that Focused Ultrasound creates a new and different type of option — one which may be more appropriate than traditional approaches for some patients.”

How does Focused Ultrasound work?

Focused Ultrasound uses real-time MR imaging to target cells in the thalamus, a part of the brain involved in essential tremor. Once these cells are located, high-frequency ultrasound waves magnify and coalesce in one spot to create a thermal lesion. The lesion destroys the cells, disrupting the process of tremor.

“Because the procedure is done in an MRI, I can precisely target and place the lesion exactly where it will be most effective,” Dr. Baltuch explained. “You can also use the MRI to control the size of the lesion,” he continued. “So, it’s really like a thalamotomy — but in a very, very controlled fashion, and without an incision.”

Focused Ultrasound is a relatively new medical technology in the United States. In May 2017, Dr. Baltuch performed the first Focused Ultrasound procedure in Pennsylvania. “There are about 30 machines now in about 10 different countries, and there have been a total of about 1,000 of these procedures performed worldwide,” he explained.

When to refer a patient for Focused Ultrasound

The first line therapy for essential tremor is medical therapy — typically a combination of beta blockers and primidone, Topamax, topiramate, etc.

If your patient meets all points of listed criteria, they may benefit from Focused Ultrasound to treat their movement disorder and should consult with Penn Neurosurgery to see if they would be a candidate.

  • Patient is refractory on medical therapy or cannot tolerate medication side effects
  • Patient is not a surgical candidate
  • Patient still suffers significant difficulty with daily activities (writing, holding utensils, dressing, etc.) as the result of a movement disorder

How to Refer

If you think your ET patient may be a candidate for Focused Ultrasound, or would like to discuss a patient or make a referral, please contact Penn Neurosurgery: Call 215-829-6700 or submit a referral form.

Neurosurgery at Penn Medicine

In addition to directing the Penn Center for Functional and Restorative Neurosurgery, Dr. Baltuch is a professor of Neurosurgery at Pennsylvania Hospital.

About this Blog

The Penn Physician Blog is a resource for health care professionals featuring Penn Medicine physicians and their research, innovations, programs and events. 

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