PITTSBURGH (KDKA) — Don Wahl was so self-conscious, he wouldn’t go out to eat. “I couldn’t eat with my right hand. I couldn’t drink with my right hand. Even on a big spoon, I would shake it all off, by the time I’d get it up there.”
He has a condition called essential tremor. It was drastically worse in his right hand, his dominant hand…and especially noticeable when he had to hold his hand steady. It also made his job as a mechanic nearly impossible. “It eventually got to where you could not get a nut on a bolt, or if you did, gonna take you four or five times as long.”
He tried medicines, which eventually stopped working. Then, his tremor got so bad, he couldn’t even carry out basic functions. “My wife actually had to feed me.”
His son saw that a medical center in Virginia was offering a new treatment called High-Intensity Focused Ultrasound, or HIFU for short.
But the waiting list was immense.
“I was like 90-something on a list of 400 and something,” says Don.
Then the Rockefeller Neuroscience Institute at West Virginia University started up a program. Don wouldn’t have to wait. He’d be their first patient.
They asked him if they could film the treatment.
“And I said, well, sure, and they said, especially since you’re the first. And I thought, ‘What?'”
The three-hour procedure involves wearing a special helmet in an MRI machine. The helmet beams ultrasound waves, the same type of sound wave energy used to look at the heart or a developing baby, but turned up intensely to generate heat.
“This technology allows these thousand ultrasound beams to converge together at one point. In the brain. In this specific case, the area that’s generating the tremor,” says Dr. Ali Rezai, a neurosurgeon at the Rockefeller Neuroscience Institute.
The area the doctors are targetting with the ultrasound is an oval structure deep in the brain called the thalamus. It’s a big hub, connecting nerves for movement, sensation, coordination, consciousness, and thinking.
The nerves behind the tremor’s back and forth, or oscillatory, movement come through the thalamus.
“If we disrupt that, it really stops the oscillatory kind of movement,” says WVU movement disorders specialist, Dr. Ann Murray.
The doctors applied the HIFU, then pulled Don out of the scanner to check his response. He had four rounds, and each time, the tremor tapered off more and more.
“I was expecting improvement, but the amount of improvement I got I’m just amazed,” Don says, “And there was absolutely no pain involved.”
“All of them, on the table, their tremor stops,” says Dr. Rezai, “We may have to make adjustments, and if the temporary benefits look good, then we make a permanent scar.”
“Some people told me there were several people in there that was so happy for me,” Don says, “They told me they couldn’t help but cry.”
It doesn’t require surgery. so you’re not cutting the skin, or in this case, you’re not putting a hole in the skull.
But you do have to be able to lie flat. And your skull can’t be too thick, or the sound waves won’t penetrate properly.
“In general, we get a 70 percent reduction in tremor,” says Dr. Rezai, “A small number of patients may require another focused ultrasound treatment if the tremor comes back. The limitation of high-frequency ultrasound is we really can only do it one side safely. We never like to create two lesions. The biggest risk is one to two percent chance of patients having unsteadiness, and walking difficulties that take some time to recover.”
It is FDA approved, but Medicare may not cover it in some states. In West Virginia, coverage has not been a problem, so people from other states with essential tremors are now coming there for HIFU.
“I was hoping just to be able to eat something, not be completely still. I’m not 100% still, but I’m at least 90-some percent,” Don remarks, “We went to the beach here, a couple weeks ago, and I wasn’t embarrassed about going out and eating in the restaurants. It’d been a long time since I was relaxed like that, thinking I can get this food up to my mouth without throwing it all over the floor.”
Just one of the many difficult tasks for people like Don, made simple again, thanks to this breakthrough treatment.