Jui-Cheng Chen /Director of the Division of Neurology, China Medical University Hsinchu Hospital /Attending physician of the Division of Neurology, China Medical University Hospital
What is Magnetic Resonance-guided Focused Ultrasound?
Magnetic Resonance-guided Focused Ultrasound, also known as “MRgFUS,” was done by wearing the focused ultrasound helmet with 1024 elements attached to the head similar to concentrating the sunlight on a point with a magnifying glass. The energy on the helmet focuses on deep brain, particularly the nucleus ventralis intermedius in the thalamus to treat tremor. Traditionally, we only treat one side of the limbs and although it could already substantially improve the syndromes of the patient, there is still imperfection to the treatment since the majority of daily activities still very much depend on both hands.
Milestone in Treatment of Bilateral Tremor
Last year, 74-year-old patient Mr. Zhou who suffered from “Essential Tremor” for 10 years and his hands involuntarily trembled. As a result, when Mr. Zhou withdrew money from the bank but could not stop trembling as he signed his signature, it would draw special attention from the bank teller and the security guard because they suspected him in a great stress. It was an extremely embarrassing moment for him. After receiving the treatment, Mr. Zou now writes with his right hand from illegible writing to printed writing. His right hand no longer shakes and he is free from misunderstanding when withdrawing the money from the bank (Figure 1). Apart from writing, Mr. Zhou also finds it relatively easy to use chopsticks and spoons with his right hand, which substantially improves his quality of living. Nonetheless, it still bothered Ms. Zhou that his left hand still trembled. He still had trouble carrying the bowl or the cup. Mr. Zhou then went to CMUH and searched for help from the movement disorder specialist team. The team treated Mr. Zhou’s left-and tremor with MRgFUS and removed his trouble over the years. Mr. Zhou is the first patient for receiving treatment on bilateral tremor.
Director Jui-Cheng Chen, director of the Division of Neurology, China Medical University Hsinchu Hospital mentioned that traditionally we used focused ultrasound treatment unilaterally because of the concern for higher risk of coarse voice or unsteady steps with bilateral treatment. Hence, even though there have been many successful treatment in one side, no hospital in Taiwan has conducted such bilateral treatment. Nonetheless, CMUH team supported the treatment with the latest “Diffusion Tensor Imaging” for the pre-treatment planing (Figure 2) and has treated the tremor of the other side after comparing the treatment positions with millimeter accuracy. This is the new milestone in the tremor treatment and the patient no longer suffered from hand tremor bilaterally.
The bilateral treatment of MRgFUS is the new achievement which many patients have been expected much. The treatment can improve the daily routines of patients so that they could restore the life of ordinary. This new milestone is expected to move tremor treatment forward so that patients can not only control their shaking hands but also their own life.
Figure 1. Director Jui-Cheng Chen with the patient.
Figure 2. Using Diffusion tensor imaging to accurately define lesions.