Incisionless Procedure Nearly Eliminates Hand Tremors in NC Man
High-Intensity Focused Ultrasound Uses Sound Waves to Interrupt Problematic Brain Signals
September 12, 2023 | By Morgan deBlecourt
Originally published on DukeHealth News and Media
David Phillips of Hope Mills, NC has had essential tremors in both hands for more than a decade. The tremors worsened over time until the 72-year-old could no longer button his shirt, drink from an open glass, or write. In January 2023, a Duke neurologist told Phillips about a new treatment called high-intensity focused ultrasound (HIFU). This short, outpatient procedure requires no incisions and offers immediate results. “I told her to sign me up,” he said. Phillips underwent HIFU for his right hand in May 2023. Today, his right-hand tremor is barely noticeable. Phillips can do things he couldn’t before and is counting down the days until he can undergo HIFU for his left hand.
Tremors Decrease Quality of Life
At first, David Phillips thought his hands were shaking because of stress. As the shaking worsened, he was eventually diagnosed with essential tremor, a neurological disorder that is often confused with Parkinson’s disease due to similar symptoms.
Over the years, it became increasingly difficult for Phillips to take care of himself and run his electric motor repair shop. “I was less and less able to use my hands to write. If you can’t write, you can’t take orders, you can’t process checks, you can’t do anything. Eventually I retired because I’d become useless,” Phillips said. He started avoiding socializing, especially eating at restaurants, because he was self-conscious about dining in public.
New Treatment Improves Tremors
Phillips tried medications to control the tremors, but results were lackluster. Phillips considered deep brain stimulation -- an implantable pacemaker-like device for the brain – but having surgery made him nervous. Then his doctor mentioned HIFU, a new treatment that uses targeted sound waves to improve tremors. Duke neurosurgeon Nandan Lad, MD, PhD, describes HIFU as “essentially a helmet with a thousand-plus ultrasound transducer beams attached to it.” Like a magnifying glass concentrates sunlight, high-energy ultrasound waves are focused on a specific spot in the brain, heating it up and disconnecting the circuit causing the tremor, Dr. Lad said.
Phillips jumped at the opportunity and scheduled the procedure.
To prepare for HIFU treatment, Phillips’ head was shaved, and a metal frame was fitted to his scalp to hold him still during the procedure. Phillips laid on an MRI bed while doctors used real-time imaging and low doses of ultrasound energy to pinpoint the target area in his brain. Then doctors carefully applied the full dose of ultrasound energy.
“They would stop every 15 seconds and have me do this test,” Phillips said. He would draw spirals, lines, and write his name. “I could see it was happening. We were all excited, and I couldn't believe it.” When the procedure was over, Phillips tremor in his right hand was almost gone. “I was giddy. I couldn't withhold my excitement. I smiled for days. I still do.” Phillips returned home the same day.
Life After HIFU
Since undergoing HIFU treatment in May, Phillips can do things he couldn’t before -- brushing his teeth, dressing himself, cooking, and taking pictures. He plans to get HIFU treatment for his left hand as soon as possible.
“This is one of a few procedures where patients are going from severe tremor to significantly less -- mild to no tremor at all -- and they can see it for themselves over the course of 90 minutes,” Dr. Lad said. “It's gratifying to be part of a great team at Duke that is able to help people improve their quality of life so quickly.”