Maryland’s Health Matters - Upper Chesapeake - Fall 2017 - 11

Center. It is one of only

are directed at a precise

FUS with colleague Dheeraj

a handful of hospitals in the

spot in the brain, traveling

Gandhi, MBBS.

country that offers FUS for

through the skull. The sonic

Paul Fishman, MD, PhD, a

essential tremor.

waves must reach the target

professor of neurology at the

brain. Through that cylinder,

at the same exact time for

University of Maryland School

electrodes are implanted in

the procedure to work.

of Medicine, says there have

the thalamus. The electrodes

HOW FUS WORKS

With DBS, neurosurgeons
drill a hole into the skull so a
cylinder can be inserted in the

Crowe was diagnosed with

"It's a bit of a race, and

been close to 800 cases

are connected by wires that

essential tremor in his 20s;

you have to make it a dead

worldwide using FUS to treat

run under the skin to a pace-

it affected every facet of

tie," says Dr. Eisenberg.

brain conditions with no

maker, which is inserted in

reports of bleeding or infec-

the chest. The pulsing elec-

his life. As the owner of a

To make sure the waves hit

small business, Crowe relied

the correct spot associated

tions. Patients who undergo

trodes can be modified at

on his secretary, who wrote

with the tremor, radiologists

FUS can have side effects,

any time to change the effect

everything for him except

use magnetic resonance

such as changes in sensation

on the tremor, and they can

his signature. He developed

imaging (MRI) to create a

in the hand or problems with

reduce the tremor by 60 to

the habit of signing his name

map of the brain and pin-

balance, but these issues are

70 percent.

with simple scribbles.

point the target. Once it's

rarely serious.

He found ways to live with

confirmed that no other parts

"DBS was one of the greatest developments in neurol-

his disease. He would lower

of the brain will be affected,

his head to the table to eat

the temperature of the sonic

soup. He'd get his friends

waves is turned up to kill the

IMPROVING ON
AN INVASIVE
SURGICAL OPTION

to shuffle and deal during

targeted cells.

Essential tremor can be

modulate brain activity with

treated medically using pro-

an implantable electrode

ogy and neurosurgery in the
last 20 years," says Dr. Fishman. "The idea that you can

regular card games. He was

During treatment, the

prescribed medication, too,

patient is awake and inter-

pranolol, but patients develop

and have that be clinically

but it lost its effectiveness.

acting with the care team.

tolerance to the drug, and the

useful-we're talking about

effects diminish over time.

150,000 people who have

"I was embarrassed around

Patients experience a 50

other people," says Crowe,

to 60 percent reduction of

Deep brain stimulation (DBS),

had this procedure done, so

who lives in Baltimore's

the tremor, allowing for a

a highly invasive treatment,

you know that's clearly the

Federal Hill neighborhood.

greater quality of life-even

has been the standard of care

standard of care."

"You're picking up something,

for those whose tremor was

over the past 15 years if medi-

and your hand is waving and

not correctable with the

cations are unsuccessful.

shaking from the tremor, and

best medicines.

someone sees you and waves

"It's noninvasive, it's

hello. And you think, 'I'm not

real-time and it produces

saying hi to you!' "

a really good result. Patients

Then a friend called to tell

DBS patients also need
future surgeries to replace

come in with tremors and

him he'd seen a commer-

they leave without hav-

cial about a new study that

ing any surgery, and their

involved treating essential

tremors are significantly

tremor with focused ultra-

diminished," says Elias R.

sound. Crowe was intrigued.

Melhem, MD, a professor and

FUS uses detailed brain

the chair of the Department

imaging and heat-generating

of Diagnostic Radiology and

sonic waves to pinpoint and

Nuclear Medicine at the Uni-

kill brain cells associated

versity of Maryland School

with the essential tremor.

of Medicine, who oversees

More than 1,000 sonic waves

the brain's imaging during

During the procedure, which lasts two to four hours,
Dr. Paul Fishman is able to test whether the targeted
treatment is effective at calming the tremor.

†To make an appointment with an essential tremor specialist, call 410-328-6034.

umuch.org | Fall 2017  11


http://www.umuch.org

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