聚焦超声治疗长达数十年的手部震颤

他后来得知自己患有特发性震颤(ET)。, 一种引起非自愿的神经系统疾病, 运动时有节奏的晃动, 最常见的是影响手. (Essential tremor is not related to Parkinson's disease, another condition marked by tremors.大约有1000万美国人有外星人. It can develop at any age but most often appears when people are between 40 和 50 years old. The condition typically worsens over time 和 can be aggravated by fatigue, 压力, 咖啡因或极端温度.

ET的确切原因尚不清楚, but a number of inherited genetic mutations have been associated with the condition. 事实上，外星人就存在于怀特黑德的家族中.

多年来, Whitehead's tremor intensified to the point where he could no longer write his name or drink from a cup without spilling. “我开始拿着汤匙出去吃饭. A regular spoon was too small 和 food would shake out. 那真的很让人恼火."

他尝试过药物治疗, but they were ineffective 和 caused unwanted side effects, 他的病情继续恶化. Then he heard about a treatment at UCSF that can help patients like him.

高强度聚焦超声 – "HIFU" for short – is an incisionless surgical procedure in which concentrated sound waves are used to target cells in a tiny area deep in the brain that is involved in generating tremors. The treatment doesn't cure ET but can significantly reduce tremors. Whitehead asked his doctor near his home in Elk Grove, California, to refer him.

“最后我给加州大学旧金山分校打了电话，中了大奖,他说. “这是一次改变人生的经历."

一种无切口治疗方案

怀特黑德被提到 UCSF运动障碍诊所 和 Dr. 多丽丝王, a neurosurgeon who specializes in caring for patients with movement disorders, including ET.

ET's first-line treatment is medications (including some used to treat high blood pressure 和 certain antiseizure meds), but up to 50% of ET patients don't respond to the drugs. 当药物治疗失败时，手术选择，比如 深部脑刺激, which involves implanting a device that sends electrical impulses to the brain to interrupt tremors, 或者消融手术, 它们通过热和辐射破坏脑组织, 非常有效.

HIFU is a new type of ablative surgery 和 has many advantages over DBS surgery, Wang says. 没必要做切口了, 和 it doesn't require putting an implant in the body that later needs to be adjusted 和 replaced. "It has higher precision 和 higher safety than traditional ablative surgery techniques," Wang says. She now uses it for patients with ET who are either not good c和idates for treatment with DBS or who do not wish to have brain implants.

In preparation for performing the treatment, Wang 和 Dr. 狮子座Sugrue, 一个neuroradiologist, use MRI to determine which specific areas of the patient's brain they will target 和 which areas they should avoid. The imaging allows them to personalize HIFU to each patient's brain anatomy, 说Sugrue, 一个neuroradiologist 和 director of the UCSF Laboratory for Precision Neuroimaging. "On the day of the procedure, we have access to all the planning we have done."

在手术过程中, 高强度声波, MRI引导, are focused on a tiny area in the brain called the ventral intermediate nucleus of the thalamus 和 dentatorubrothalamic tract. 电波穿过皮肤, skull 和 brain to safely destroy cells in the targeted area while leaving surrounding brain tissue unharmed. 病人在整个过程中都是有意识的. Improvements in the tremor are immediate, 和 patients go home an hour after the procedure.

"From the perspective of the treatment team, it's incredibly rewarding," 说Sugrue. "There are very few things that we do in medicine as satisfying as this."

一些患者会经历HIFU的副作用, 比如失衡, 麻木或头痛, but the majority of these issues resolve within 30 days. 怀特黑德说他没有任何副作用.

接受HIFU后, all patients see immediate improvement with 80 to 90% tremor reduction, 虽然这个程序相对较新, longer term follow-up studies show that tremor reduction remains at 70% five years after the treatment.

2023年1月, the Food 和 Drug Administration approved the use of HIFU on both sides of the brain in two procedures performed at least nine months apart. 以前, Sugrue解释说, 患者只能在一侧进行手术, 出于对副作用的考虑.

Sugrue thinks the success of HIFU in treating ET is the tip of the iceberg in terms of clinical uses for the technology. "I really think this is the first step in what will be a much broader application of ultrasound in neuroscience,他说. "That's one of the things to me that's particularly exciting about it."

改变生活的进步

在他接受治疗后, Whitehead was able to use his right h和 to sip from a water bottle without spilling 和 steadily put a pen to paper. "For the first time in years, I wrote my name like it was on my driver's license,他说.

回家后, he's more comfortable being active 和 social with Millie, 和他结婚50多年的妻子, 在他身边.

"You feel a lot more at ease when you're visiting with people – you don't want your tremors distracting from what you're doing,他说. “这是一次很棒的经历. 它改变了我的生活."