Focused Ultrasound for Parkinson’s Disease Now Offered at the University of Maryland Medical Center

FDA approval clears way for incisionless brain surgery as an effective, non-invasive treatment option to improve symptoms, quality of life

A non-invasive ultrasound treatment for Parkinson's disease that was tested in a pivotal trial led by University of Maryland School of Medicine (UMSOM) researchers is now more broadly available at the University of Maryland Medical Center (UMMC). Recent FDA approval of a device used in the procedure effectively opens up access to focused ultrasound beyond clinical trial participation.

The device, called Exablate Neuro and manufactured by Insightec, was approved in late 2021 by the U.S. Food and Drug Administration to treat advanced Parkinson's disease on one side of the brain. UMMC is one of only several sites in the Mid-Atlantic region with the capabilities and expertise to perform focused ultrasound for Parkinson's disease and other movement disorders. The procedure requires a multi-disciplinary team, including a neurosurgeon, movement disorder neurologist, and neuroradiologist.

Rapid Reversal of Symptoms

Focused ultrasound is a completely incisionless procedure, performed without the need for anesthesia or an in-patient stay in the hospital. Patients, who are fully alert, lie in a magnetic resonance imaging (MRI) scanner, wearing a specialized energy conversion helmet for the procedure. Ultrasonic energy is targeted through the skull to the globus pallidus, a structure deep in the brain that helps regulate voluntary movement. MRI images provide doctors with a real-time temperature map of the area under treatment.

Often before the procedure is even completed, patients experience relief from severe symptoms such as tremors, rigidity in the legs and arms, and side effects from medications that cause involuntary, erratic movements called "dyskinesia."

About one million Americans have Parkinson's disease, a neurodegenerative disorder that affects brain cells or neurons in a specific area of the brain that produce the brain chemical dopamine. Other current treatments for Parkinson's include medications and deep brain stimulation from surgically implanted electrodes.

"Focused ultrasound has less ominous side effects for patients since there's no risk of infection or damage to blood vessels from the electrodes," said Howard Eisenberg, MD, the Raymond K. Thompson Professor of Neurosurgery at UMSOM and a neurosurgeon at UMMC who served as principal investigator on the study that led to the approval of Exablate Neuro. "Presently, it can only be used to treat one side of the brain, so it may be more appropriate for patients with symptoms predominantly on one side. However, research into bilateral focused ultrasound is ongoing and shows very promising results."

Patient: Focused Ultrasound Changed My Life

Parkinson's disease not only progressively robs people of their mobility; it often erodes their social networks built over years of shared interests and experiences. Symptoms such as involuntary headshaking and jerking of the limbs can make many people who have the disease feel acutely self-conscious, to the point they withdraw from most social activity.

One man who managed to stave off this devastating outcome was an early participant in clinical trials for focused ultrasound led by UMSOM researchers at UMMC. For this patient, relief came within minutes after the procedure began--which ultimately eliminated 95% of the involuntary movements caused by his medication and reduced his tremors by half. Over seven years later, these outcomes have lasted, although his disease has advanced on other fronts.

"The focused ultrasound I received at the University of Maryland Medical Center changed my life by giving me back the ability to do the things I love. I'm in a competitive bowling league. I play golf. I ride my bike," said Steve Squires, 46, of Middlebury, Indiana, who had the procedure in 2015 as part of the pilot study.

Squires noted that while focused ultrasound isn't a cure for Parkinson's, it helped him return to many of his normal activities. "It also gave me a platform to share with others who have Parkinson's that there are new treatment options—you don't have to suffer this alone," he said.

In a pilot study published last year in the Journal of Neurosurgery, Dr. Eisenberg and his colleagues tested the focused ultrasound device on 20 patients with Parkinson's disease and found that the vast majority of patients experienced a clinically meaningful improvement in their motor-skill symptoms like tremors that lasted through one year of follow-up. Only one patient experienced a progression of their disease during that time, and none experienced any serious adverse events from the treatment itself. A more recent randomized controlled study involving 89 patients yielded similar results. It was the basis for the device approval.

"We have had great experience using this focused ultrasound technique in clinical trials and can now offer this less invasive treatment option to those with Parkinson's symptoms," said study co-author Paul Fishman, MD, PhD, Professor of Neurology at UMSOM and a neurologist at UMMC. Dheeraj Gandhi, MD, MBBS, Professor of Radiology, Neurosurgery and Neurology and Director of Interventional Neuroradiology at UMSOM, and an interventional neuroradiologist at UMMC, was also a co-author of the study. They are planning a new trial in coming months to use the device to treat patients on both sides of the brain.

A New Era for Parkinson's Disease Treatment

"A diagnosis of Parkinson's disease no longer automatically portends a future of extremely limited physical capabilities. Thanks to the commitment of researchers like Dr. Eisenberg and Dr. Fishman—and clinical trial participants like Steve Squires—treatment has expanded to include non-invasive options that significantly reduce certain symptoms within minutes and transform the lives of people who had been living with debilitating symptoms," said Bert W. O'Malley, MD, President and CEO of the University of Maryland Medical Center.

"Our school of medicine researchers have established themselves as world leaders in pioneering MRI-guided focused ultrasound for many devastating brain diseases, including Parkinson's and essential tremors," said E. Albert Reece, MD, PhD, MBA, Executive Vice President for Medical Affairs, UM Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor and Dean, University of Maryland School of Medicine. "The stellar work of Dr. Eisenberg and Dr. Fishman has led to a new era in which this breakthrough modality has now become the standard of care for patients looking for less invasive treatments for their symptoms."

Connecting to Treatment for Movement Disorders

Typically, patients will see a movement disorder specialist prior to consideration for focused ultrasound therapy. The University of Maryland Parkinson's Disease and Movement Disorders Center provides evaluation, care, and treatment for patients with a wide variety of movement disorders such as essential tremor, Parkinson's disease, and dystonia. It is staffed by 6 board-certified neurologists. To make an appointment with one of our Movement Disorder Specialists, call 410-328-4323.

To schedule a consultation with one of our neurosurgeons, call 410-328-6034. Learn more about our Neurosurgery services.

About the University of Maryland Medical Center

The University of Maryland Medical Center (UMMC) is comprised of two hospital campuses in Baltimore: the 800-bed flagship institution of the 13-hospital University of Maryland Medical System (UMMS) and the 200-bed UMMC Midtown Campus. Both campuses are academic medical centers for training physicians and health professionals and for pursuing research and innovation to improve health. UMMC's downtown campus is a national and regional referral center for trauma, cancer care, neurosciences, advanced cardiovascular care, and women's and children's health, and has one of the largest solid organ transplant programs in the country. All physicians on staff at the downtown campus are clinical faculty physicians of the University of Maryland School of Medicine. The UMMC Midtown Campus medical staff is predominately faculty physicians specializing in a wide spectrum of medical and surgical subspecialties, primary care for adults and children and behavioral health. UMMC Midtown has been a teaching hospital for 140 years and is located one mile away from the downtown campus. For more information, visit www.umm.edu.

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world -- with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.2 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System ("University of Maryland Medicine") has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu.

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