‘Outer space science’ brain surgery ends tremors without putting patients under the knife

After having her head shaved by nurses at the Novant Health Mint Hill Medical Center in Charlotte, in the US state of North Carolina, Catherine Klie’s right hand shook as she tried to trace spiral circles and straight lines with a marker. It did not look good, with scribbly markings on the test paper. Tremors run in her family, and began affecting her in her twenties. The hereditary condition has since had a large impact on the 78-year-old’s life and stopped her from performing small routine activities that most people take for granted. “I know for a guy it’s different, but I can’t do my nails, I can’t do my make-up, I can’t use a curling iron,” Klie said. “It’s all those small things that you don’t really think about that you can’t do.” But a brain procedure at the facility helped change that, where for neurosurgeon Dr Charles Munyon, the most fascinating part of his work is removing tremors without putting patients under the knife. On September 29, Klie became the 709th incisionless brain surgery patient. The medical centre celebrated its 700th surgery in August. The surgery was a success. Klie allowed local newspaper The Charlotte Observer to watch and document it. Munyon performed Klie’s surgery, which used high-energy ultrasound waves to target areas of the brain and improve tremors through technology from Insightec, a company that treats medical conditions with advanced MRI-guided focused ultrasound. Disorders such as tremors can be traced to specific misbehaving circuits in the brain, Munyon said while explaining the procedure. Focused ultrasound is a less invasive approach than procedures such as deep-brain stimulation, which involves inserting wires into the brain to use electricity to regulate activity in these circuits. “But for a lot of patients, that’s a lot to go through,” Munyon said. The ultrasound works by using high-energy sound waves aimed to meet at a single focal point inside the brain. This concentration of energy creates a tiny, controlled burn that interrupts the faulty circuit that is causing the tremor. “We’re using sound waves coming from all around the top of the head, and each individual sound wave is carrying a certain amount of energy, but not enough to damage any of the tissue that it’s travelling through,” Munyon said. The Mint Hill centre was one of the few accepting Medicare, a federal health insurance programme for people aged 65 or older and younger people with disabilities, to use the ultrasound brain surgery for Parkinson’s disease. This drew residents from all over the United States. Follow-up data showed that most patients who underwent the surgery had improved quality of life. More than half saw better control of their tremors. Munyon finds it rewarding to hear from patients a few weeks after their procedure. “They’ve started to really have a chance to see what they can do,” he said. “Some of them will show me pictures that they’ve painted, drawings that they’ve done, or just their handwriting … or they’ll tell me about the projects they’re working on, or just about going out to eat with friends and not being embarrassed by their hands shaking.” And he made Klie feel at ease. “If anybody is playing with my brain, I have to check them out,” she said with a chuckle. “I had concerns, but everything I found was very positive.” Before the surgery, it was a challenge for Klie to do everyday things such as use a computer or a mobile phone. She took medication for her tremors, but the relief was only temporary and came with side effects. “I’m winding up taking handfuls of pills that really are barely working, and I don’t like that either,” she says. After learning about the procedure from a TV segment several years ago, she kept up with research and new advancements. She was later referred by her primary care doctor. Inside the MRI machine, a special membrane filled with cold water was placed on Klie’s head for cooling and to aid sound wave transmission. Munyon monitored her progress on a computer screen that displayed images of her brain with colourful spots indicating heat. He turned up the energy for treatment to create lesions to interrupt the circuits causing tremors. The procedure lasted over an hour, after which Klie’s right hand was notably steadier. “Look at that,” she said after the surgery. “It’s been years since I had a hand like that … it feels strange not to shake.” Klie then went to her room with her husband, Tim, and ate pieces of a granola bar with a steady hand, with no stiffness or tingling. “I just find this absolutely amazing,” she said. She also sipped from a cup on her desk. “I remember when I picked up a glass with my right hand, I couldn’t do it because I’d spill it,” she said. She was expecting more discomfort, but that did not happen. She described her experience as “outer space science” with the water membrane on her head. “The water was freezing cold, but you could hear the water sloshing around … it’s a very strange sensation. I thought it was going to be much more uncomfortable than it was.” Tim is happy knowing that his wife’s quality of life will improve. “Probably mine, too,” he said with a laugh. He said Klie was really self-conscious when they went out in public. “It was like she had a big sign saying ‘watch me shake’,” he said. “Even the things you take casually, like reaching for a fork, we don’t think anything about it. But for her, it’s a chore.” Klie was motivated to undergo the procedure to encourage her family members with tremors to get treatment sooner. She wants to set an example for her 17-year-old grandson, who was recently diagnosed. One of her nephews had to drop out of architecture school because of his tremors. “I’m hoping that maybe he won’t have to get to a point where he’s 78 years old and needs [medication],” she said. Munyon worked on Klie’s right hand first since it is her dominant hand. She is planning to return in several months for the left. Klie said the surgery has got her back into life again. One of the things she is looking forward to is going to her grandchild’s wedding. “I’ll be able to toast them and not spill all over the place. It’s just a huge thing, and I’m just so excited about it.”

‘Outer space science’ brain surgery ends tremors without putting patients under the knife

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}At a medical centre in the US, a procedure using ultrasound waves to disrupt misbehaving circuits in the brain has helped hundreds of people

At a medical centre in the US, a procedure using ultrasound waves to disrupt misbehaving circuits in the brain has helped hundreds of people