Read the Transcript

MR-guided Focused Ultrasound Treatment for Essential Tremor

Intro: This is Weekly Dose of Wellness, brought to you by Memorial Care Health Systems. Here's Deborah Howell.

Deborah Howell (Host): Hello, and welcome to the show. I'm Deborah Howell, and there's some good news for essential tremor patients. And we'll hear about this new course of treatment today as we talk about MR-guided focused ultrasound treatment. Our guest is Dr. Devin Binder, a board-certified and fellowship-trained neurosurgeon at Orange Coast Medical Center. Welcome, Dr. Binder.

Dr Devin Binder: Good morning. Thanks for doing this.

Host: Lovely to have you on with us today. So, what are some of the common symptoms associated with an essential tremor?

Dr Devin Binder: Essential tremor involves tremors that are most obvious in the hands. And that makes it very difficult to do tasks with the hands such as writing, eating and drinking, and dressing oneself. Tremors can also involve the head and voice.

Host: Interesting. And how is a patient diagnosed with essential tremor?

Dr Devin Binder: With the history and physical examination, often there's a family history of tremor, but not in all cases. But the physical examination of a patient with essential tremor will include what we call action tremor, where the patient reaches for something with the hands and the tremor gets worse during the movement. And that creates a lot of problems doing things such as fine motor activities.

Host: Who is a candidate for MR-guided focused ultrasound treatment?

Dr Devin Binder: So, we have two categories of people that are treated currently with MR-guided focused ultrasound for tremor. One is the patient with confirmed diagnosis of essential tremor. And the second category is people with Parkinson's disease that have significant tremor.

Host: All right. Now, to the meat of the matter. What is MR-guided focused ultrasound treatment and how has it performed?

Dr Devin Binder: A focused ultrasound is a technology that allows us to focus ultrasound energy into a deep target and tissue. In the case of the brain, we deliver it to target that controls the tremor and the MR-guided is very important. The MRI creates a very detailed picture of the brain and gives us the target. And then, we can use the ultrasound energy at that target to treat the tremor.

Host: Fascinating stuff. What are some of the benefits of this procedure?

Dr Devin Binder: The most important thing is to eliminate the tremor by at least 80-90%. Some of our patients do get 100% tremor relief, but we're aiming for at least 80-90% relief of the tremor. And that's significant to improve the use of that hand and to improve the quality of life.

Host: And so, how long is the effect of the treatment expected to last?

Dr Devin Binder: Permanent. So based on the original studies of this, we deliver enough ultrasound energy to that target to permanently eliminate the tremor circuit within the brain. And that's something that, if we don't deliver enough energy, it's a temporary effect. But if we deliver enough energy and after all the studies that have been done, we can now make this a permanent effect on tremor.

Host: That is surprising and good news indeed. Do you ever need to tweak someone if you maybe got 90% and you want to later try for the other 10%?

Dr Devin Binder: Yes, that's happened in some cases. Although as this technology has progressed, we're much better now at getting the full tremor relief permanently at the first treatment. And that's something that we have very careful feedback during the procedure with the patient doing spiral diagrams and various types of writing and fine motor activities so we can make sure to get rid of most of the tremor just at the first treatment.

Host: Wow. That's got to be kind of life-changing if you couldn't sign your name before and then afterwards, you're okay to do it.

Dr Devin Binder: Absolutely. It's writing, it's things like eating, holding a cup, pouring water, fine motor activities such as buttoning, dressing, people that like to do painting or work on their cars or whatever they want to do with that hand with fine motor activities. It's extremely life-changing. When we hit the target, it's very fulfilling.

Host: I love it. What side effects can be expected during and after the treatment.

Dr Devin Binder: Because we are creating a lesion in the brain, a small little area. There's some swelling that can occur in the brain right after the treatment. So, we do have some temporary issues in patients such as numbness or tingling in the hand or face on the side of the treatment. And also, balance may be off for a few weeks. So in that situation, we make sure that there's someone watching the patient for awhile. Those are most often temporary, those side effects.

Host: How soon can a patient get back to routine daily activities after having the treatment?

Dr Devin Binder: This is incisionless. This is like an outpatient radiology-based procedure. So, there's no incision to heal, there's no dressings in place, anything. And so, patients really return to normal activities within a few days. We do ask people to take it easy for about two weeks after this procedure, though.

Host: Okay. And is this procedure covered by Medicare and most insurance plans?

Dr Devin Binder: Yes. It's completely covered by Medicare, and the private insurers have gone along with Medicare as usual. So, absolutely, the answer is yes, it is covered.

Host: You are just full of good news today, doctor. This is just amazing. Now, some more good news. What support and resources are available after treatment to a patient through the Neuroscience Institute Movement Disorders program at Orange Coast Medical Center?

Dr Devin Binder: Yes. Thank you. So, the first step is the postoperative MRI scan that we do to assess the accuracy of the treatment. We do that routinely and we offer that on postoperative day number one. So, that's report card on the treatment and we do that and then get that back to the patient. That gives us the idea of how effective the treatment will be.

The second part is we do follow up calls within the first week of treatment to make sure that the patient is doing well. And then, we have a longer term follow-up evaluation for one year after treatment to make sure that there's a sustained improvement. And then as you indicated, if there's any residual tremor, we can consider other treatment for the patient. We also communicate with patients' local physicians as needed. Many of our patients are coming from out of town. And so we want to share all the information about the treatment with the patients, other physicians.

And last but not least, we like to really take down, for our own benefit and also for the benefit of the program, the stories of these patients' tremor, so that we will be able to document going forward how we're helping people.

Host: Do you have an instance of a dramatic life change for one of your patients that you could share?

Dr Devin Binder: Yeah. So, we have treated several patients recently. One of whom just sent us a video yesterday showing that he's able to actually eat soup. And this brought this huge smile to his face. And he indicated that before this treatment, it would be all over him. The tremor was so severe that he would have spilled everything on his front or on his face or on his head. So, that's the type of video that we love to see from our patients, because it indicates that they're going about their lives, able to use that hand without problems.

Host: Now, I'm thinking about when you said it can also affect the voice and thinking about, of course, Katharine Hepburn, did she have an essential tremor or was that something else?

Dr Devin Binder: Yes, Katharine Hepburn, wonderful actress and wonderful movies. Bringing Up Baby was my favorite movie of hers. Anyway, she had Parkinson's disease, but she had tremor. And that's, as I indicated, one of the categories of patients we can treat as well, patients with Parkinson's that have a lot of tremor. The vocal tremor does not respond so well to this treatment, but the hand tremor does.

Host: Okay. I feel like I know a lot of people with shaky hands. Is this always essential tremor or can it be other things?

Dr Devin Binder: The two most common causes of tremor in the hands are essential tremor and Parkinson's disease. And it's important in people that are considering this to get an accurate diagnosis first of whether it's essential tremor or it's Parkinson's, because the treatment options and medications are very, very different.

Host: But you say that it does have some effect for people who do have Parkinson's?

Dr Devin Binder: Yes, absolutely. So, we can treat people with what's called tremor-dominant Parkinson's disease. So if they have largely tremor as part of their Parkinson's symptoms, then we can treat them. This particular treatment is for tremor. The other symptoms of Parkinson's disease, such as rigidity, stiffness, that type of thing are not treated with this form of treatment, just the tremor.

Host: Got it. Well, thank you so much for all this good news, Dr. Binder, for being on our show today and, of course, for being an essential frontline worker for us. It's been great talking to you.

Dr Devin Binder: Thank you so much.

Host: To listen to the podcast or for more information, visit That's Memorial Thanks for listening and have yourself a fantastic day.

Essential Tremor (ET) affects about 10 million Americans. ET is a neurological condition causing shaking of the hands, head and voice, but it can also cause the legs and trunk to shake. It’s often confused with Parkinson’s disease, although it is eight times more common. MemorialCare Orange Coast Medical Center now offers a new, incisionless procedure for people suffering from Essential Tremor using a method called MR-guided Focused Ultrasound for treatment of ET in the dominant hand, as well as those with tremor-dominant Parkinson’s-disease. Board-Certified and Fellowship-Trained Neurosurgeon, Devin K. Binder, M.D., Ph.D.discusses how this Medicare-covered treatment is performed, who is eligible as a candidate, benefits of the procedure and what to expect post-procedure.