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BackTable / MSK / Podcast / Episode #16

Transcranial Focused Ultrasound for Tremor: Next Generation Image-Guided Therapy for the Brain

with Dr. Bhavya Shah

In this episode, host Dr. Jacob Fleming interviews one of his attendings Dr. Bhavya Shah about the remarkable features of focused ultrasound technology and its applications. They discuss its dynamic nature, allowing for a wide range of applications.

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Transcranial Focused Ultrasound for Tremor: Next Generation Image-Guided Therapy for the Brain with Dr. Bhavya Shah on the BackTable MSK Podcast)
Ep 16 Transcranial Focused Ultrasound for Tremor: Next Generation Image-Guided Therapy for the Brain with Dr. Bhavya Shah
00:00 / 01:04

BackTable, LLC (Producer). (2023, June 21). Ep. 16 – Transcranial Focused Ultrasound for Tremor: Next Generation Image-Guided Therapy for the Brain [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Bhavya Shah discusses Transcranial Focused Ultrasound for Tremor: Next Generation Image-Guided Therapy for the Brain on the BackTable 16 Podcast

Dr. Bhavya Shah

Dr. Bhavya Shah is a practicing neuroradiologist with UT Southwestern in Dallas, Texas.

Dr. Jacob Fleming discusses Transcranial Focused Ultrasound for Tremor: Next Generation Image-Guided Therapy for the Brain on the BackTable 16 Podcast

Dr. Jacob Fleming

Dr. Jacob Fleming is a diagnostic radiology resident and future MSK interventional radiologist in Dallas, Texas.

Synopsis

Dr. Bhavya Shah is a neuroradiologist at UT Southwestern in Dallas, TX and the director of their transcranial-focused ultrasound lab. While in residency at Boston MIT, he studied the radiology applications for nerve regeneration and expanded his scope of practice during his fellowship at Stanford. Dr. Bhavya Shah explains the use of low intensity focused ultrasound (LIFU) and high intensity focused ultrasound (HIFU), particularly in the context of movement disorders including essential tremor and Parkinson’s disease. LIFU is used to identify the appropriate targets in the brain in relation to the disease and may be used to alter how neurons behave. In contrast, high intensity focused ultrasound (HIFU) is utilized to ablate and destroy tissues typically after the localization of the intended treatment area.

Dr. Shah developed a way to identify targets in the brain for treatment with focused ultrasound with the use of four-tract tractography in cadavers. Using this technology, the brain can be thinly sliced into sections which could then be registered off an MRI back to the path using block face photography, allowing the identification of white matter tracts that enter and leave the thalamus. With these tracts identified, neuroradiologists can first stimulate the localized area with LIFU to confirm the location, then ablate using HIFU. The procedure lasts approximately 30-45 minutes as the patient remains awake. Remarkably, patients with essential tremor usually experience benefit immediately following the procedure as patients with Parkinson’s have symptom improvement within days to weeks. After two hours of observation, patients are discharged assuming no side effects. Side effects are uncommon but can include numbness and tingling around the mouth or fingertips as well as muscle weakness.

Beyond its use for movement disorders, the adaptable nature of focused ultrasound technology shows promise for a broad range of applications, particularly for the use of neuropsychiatric conditions. Dr. Shah offers the potential for the use of HIFU as a wearable device that delivers constant stimulation modulated by biofeedback, potentially eliminating the need for MRI for the procedure. Dr. Shah and Dr. Fleming end the discussion with how radiology has evolved over the years and the importance of keeping an open mind working in a multidisciplinary team. They emphasize the gravity of patient engagement and the central goal of medicine and improving the standard of care should always be aimed at benefiting the patient.

Resources

MRI–Guided Focused Ultrasound Thalamotomy for Essential Tremor:
https://thejns.org/view/journals/j-neurosurg/138/4/article-p1028.xml

Trial of Globus Pallidus Focused Ultrasound Ablation in Parkinson’s Disease:
https://www.nejm.org/doi/10.1056/NEJMoa2202721

Long-term effects of bilateral subthalamic nucleus deep brain stimulation on gait disorders in Parkinson's disease: a clinical-instrumental study
https://pubmed.ncbi.nlm.nih.gov/37208527/

Magnetic Resonance Image Guided Focused Ultrasound Thalamotomy. A Single Center Experience With 160 Procedures:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894664/

Transcript Preview

[Dr. Jacob Fleming]
Absolutely. So am I. I think this is such a cool topic. Let's dive right in. What the heck is HIFU, first of all?

[Dr. Bhavya Shah]
HIFU, everybody calls it HIFU, it's a high-intensity focused ultrasound. It's important to note it's called focused ultrasound, and high-intensity and low-intensity, there's different applications depending on the duty cycle that you're using and things like that, so focused ultrasound, high-intensity applications, and low-intensity applications. It's the ability to focus ultrasound waves onto a single point and use it to change how neurons behave if you're using low-intensity and then ablate tissue or destroy tissue if you're using high-intensity with applications in the brain and outside of the brain, obviously.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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