September 19, 2024 • 16 mins
Tremor is a neurological condition that affects approximately 1% of the population overall, and 5% of adults age 60 and over. It is expected to increasingly impact Delawareans as the state's population ages.
A new treatment for people suffering from essential tremor and Parkinson's Disease is a game-changer for ChristianaCare patients. Dr. Justin Martello, Director of the Parkinson's and Movement Disorders Program at ChristianaCare, shares inspiring insights into MR-guided focused ultrasound, including how it works, exciting success stories, and potential uses for this technology for treating other conditions.
Justin Martello, M.D., is a board certified neurologist specializing in movement disorders and Parkinson's Disease at ChristianaCare. As Director of the Parkinson's and Movement Disorders Program at ChristianaCare, he has developed Delaware's first and only comprehensive Parkinson's disease program.
Links
- ChristianaCare News - ChristianaCare Is First in Delaware to Offer MR-Guided Ultrasound for Essential and Parkinson’s Tremor
- ChristianaCare Parkinson's and Movement Disorders Program
- MR-Guided Focused Ultrasound
- Harnessing the Power of Ultrasound to Treat Essential Tremors
- Parkinson's Disease of Delaware
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:02):
It can heat up those cells in order to kill them, to
make them stop causing thetremors.
Speaker 2 (00:09):
You're listening to For the Love of Health, a
podcast about delivering careand creating health, brought to
you by Christiana Care.
And now here are your hosts.
Speaker 3 (00:19):
Hello everyone, I'm Megan McGerman.
Speaker 2 (00:21):
And I'm Jason Tokarski.
Welcome to For the Love ofHealth brought to you by
ChristianaCare.
Speaker 3 (00:25):
Tremor is a neurological condition that
affects approximately 1% of thepopulation overall and 5% of
adults age 60 and over.
It is expected to increasinglyimpact Delawareans as the
state's population ages.
Speaker 2 (00:40):
A new treatment for people suffering from essential
tremor and Parkinson's diseaseis a game changer for
ChristianaCare patients.
Here to tell us more is DrJustin Martello, Director of the
Parkinson's and MovementDisorders Program and the
Focused Ultrasound Program atChristianaCare.
Speaker 3 (00:55):
Justin, thank you so much for your time today.
Speaker 1 (00:57):
Thanks for having me.
Speaker 3 (00:59):
Let's start with definitions.
What is tremor, and how does itdiffer from Parkinson's disease
?
Speaker 1 (01:05):
And a lot of people make that mistake.
Everyone thinks tremors or theshaking of your hands usually
involves your hands, happenseither in old people or in
Parkinson's disease, as youmentioned.
But actually the most commonreason for people having tremor,
or the most common movementdisorder, is actually called
essential tremor.
Don't ask me how they got thename, because people will tell
(01:26):
me there's nothing essentialabout it.
It is something that usuallyhappens later in life, although
younger people can get it too.
It usually involves the hands,as I mentioned, and really when
you're using your hands, sopicking up a cup, usually it's a
very gradually progressiveissue, usually involving both
hands the same, whereas inParkinson's disease, patients
(01:49):
usually get a tremor whenthey're at rest, so they're
resting their hands in theirlaps and then start shaking on
its own.
That's not always the case.
In about a third of Parkinson'spatients don't have tremors,
but that's usually the form oftremor that they have Now, with
essential tremor again over manyyears.
So patients usually in thebeginning just notice a little
bit of shaking Maybe they'reholding the glass or doing their
makeup or brushing their teethand then eventually it starts
getting worse and worse, to thepoint where writing becomes, you
(02:13):
know, impossible.
So signing your name, which westill have to do on like checks
and other important financialpaperwork, so signing things
again, holding a glass withoutneeding two hands or needing a
straw to.
You know it's a lot of littlethings throughout the day and
these things start to build up.
I just had a patient actuallytoday who was lamenting that
(02:34):
trying to put his golf ball onthe tee just couldn't do it, and
you know people are therewaiting for him and he just
could not get it.
So it affects, you know, itstarts building up and quality
of life starts becoming more ofa problem.
Speaker 2 (02:47):
What is the historical treatment for these
tremors?
Speaker 1 (02:51):
Usually we typically start with medications.
Now there aren't that manymedications, so there's really
two first line options.
One is called primidone, theother one's called propranolol.
They're very old medicines,actually first created for other
uses and then repurposed in thetremor world, but now we really
just use them for tremorcontrol.
And then after that there's asecond line agent called
(03:11):
topiramate, and then after thatthere are several, you know,
third and fourth line agents.
But once you get past the firstfew the likelihood that they're
going to be really helpful foryour tremor just goes, you know,
drops off pretty significantly.
That they're going to be reallyhelpful for your tremor just
goes, you know, drops off prettysignificantly.
And so most people get to apoint where either the
medications don't work anymoreor they can't use them because
of other, you know medicaldiseases that they have or other
(03:34):
medications thatcontraindicated you know to use
them both, or they have sideeffects.
And so most of the time theyget to a point where medications
are no longer an option andthey need to look for what we
call more of the proceduraloptions or advanced treatment
options.
Speaker 3 (03:49):
So an advanced treatment option that you're now
doing here at Christiana Careis the MR-guided focused
ultrasound Correct.
Explain to us how that works.
Speaker 1 (03:58):
So we actually know this procedure works because
back in the 60s and 70s wellbefore that we knew that there's
an area in your brain thatcauses the tremors.
You actually have one on eitherside of your brain contributing
to tremors on the opposite sideof your body.
Now, in the 60s and 70s, therewas this procedure where we
would open up your skull, sticka probe down, burn that area to
(04:19):
kill the cells that are causingthe tremors and it would stop
the tremors.
So now we're able to do itwithout all the cutting or
operating on your head, usingultrasound waves.
So ultrasounds normally areharmless, but if we take 1,000
ultrasound waves and they allintersect at one area of your
brain, it can heat up thosecells in order to kill them, to
(04:42):
make them stop causing thetremors.
And we do it in such a fine wayand we use the MRI machine to
really not only locate that areaof your brain that we're
targeting, but also to measurehow much heat we're delivering.
Because that actually is what'shappening.
When all the ultrasound wavesare intersecting at one point it
starts to heat up those cellsand so we can actually measure
(05:02):
the temperature that we'reheating it up in order to
permanently kill the cells andactually that's how we're able
to avoid a lot of the sideeffects is we can deliver low
levels of energy in thebeginning to kind of like stun
the cells.
And then we're constantly goingin and out of the MRI machine
saying like, how do you feel wetreated with a low level of
energy?
(05:22):
And if their tremors start toslow down and they say I had no
side effects, we know we're inthe right spot.
If the tremors are the same andthey're like well, maybe I have
numbness or tingling, okay,we're not in the right area.
We move, no permanent damage isdone.
So we kind of use low levelsand then we crank up the heat in
order to permanently kill thosecells when we know we're in the
right area and it's anoutpatient procedure, so you go
(05:45):
home the same day and there's norehab or medications you need
afterwards.
So it's a very appealing optionfor people who don't want a
more invasive brain surgery.
Speaker 3 (05:55):
It's not an invasive brain surgery, but killing brain
cells still, I'm sure givespeople pause.
So are these brain cells thatyou really don't need?
How does that work?
Speaker 1 (06:06):
Yeah.
So again, it's kind of thetremor center of everyone's
brain.
Everyone has it.
That's why, you see, wheneverpeople are nervous or excited or
fearful, they kind of shake.
It's interesting.
There's some arguments as far aswhy we have this area of our
brain, but we do know thatthat's really all it contributes
to as far as function.
(06:27):
It does not really play a rolein any other kind of physical or
motor function or personalityor memories or anything, and in
fact it's actually far away fromthose things.
Like you know, your thinkingand memory and personality.
And, like I said, we were ableto do this procedure in a much
more invasive way and we knew itwas even safe doing it more
invasively and reallycontributed to just little to no
(06:51):
tremors without causing anyother kind of problems.
Having said that, there areareas around this tremor center
that we want to avoid treating,because we do know that you can
have some side effects rightfrom the procedure.
Everything can have side effects, and so some of them include
numbness and tingling, as Imentioned, usually of your hands
, sometimes of the mouth,balance issues walking in
(07:13):
balance.
So that's the one thing that wecan't really test for while
you're on the MRI machine.
You're just kind of on thetable and so we're not getting
you up and walking you around,and so that is one of the things
that we worry about the most.
Usually it's not significantbalance issues afterwards, but
there is about a 14% chance thatthat could be a permanent kind
of mild worsening of yourbalance and walking, and so
(07:34):
that's the thing that we worryabout the most.
The other things are usuallytemporary and go away weeks to
months after the procedure.
Speaker 2 (07:42):
And, as seems to be the case with a lot of brain
surgeries, you made it soundlike that the patient is awake
through this procedure.
Are you having them do somekinds of tests, aside from just
how do you feel right now in theprocess?
Speaker 1 (07:55):
Yeah, and a lot of people will say, oh, I'm
claustrophobic, I need somethingto calm me down, right, but we
actually don't give you anymedicines.
You're fully awake.
No sedating medicines, becausethat will dampen the tremor.
We want you fully awake,telling us not only how you feel
while we're delivering theultrasound energy, which, by the
way, only takes several seconds, maybe 15 seconds to 20 seconds
(08:16):
at a time, so it's very quick.
We want the tremors at theirworst.
So we even have you come offyour tremor medicines before the
procedure, so you're at yourworst, and then we can see in
real time, as we're deliveringthe energy, the tremor kind of
go away, which is kind ofamazing when you think about it.
We have them draw spiralsthroughout the procedure to kind
of test their tremors.
We have them do otheractivities, sometimes like
(08:38):
pretending to drink from abottle and really bring out the
tremor, Because some people willsay my tremors really come out
with this sort of action or thissort of activity.
So we try and mimic how badtheir tremor is at their worst
so we can see in real time howthey improve.
And so we're constantly goingin and out of the MRI machines,
doing the spirals, doinghandwriting samples to really
(08:59):
see that effect.
Speaker 2 (09:00):
Christiana Care is the first health center in
Delaware to provide thisprocedure.
There are others in the nationwho are doing it, but what
really is setting ChristianaCare's offering of this
procedure apart from others?
Speaker 1 (09:13):
So we are the only center in the whole country
where the procedure is run bythe neurologist or by the
movement disorder specialist ormyself.
Usually it's done by aneurosurgeon, specifically a
functional neurosurgeon, butthere are centers that use
neuroradiologists.
There's actually two others whouse neuroradiologists, but
neurologists have been involvedin the procedure in other
(09:34):
centers, but at Christiana CareI'm the one running the whole
show without the role of afunctional neurosurgeon being
involved, and so that is unique,not only in the setting of not
having a functional neurosurgeoninvolved, but also with
neurosurgeons.
They don't follow patients overtime, right, yeah, they'll have
some pre-op appointments andpost-op appointments, but I'm
(09:58):
the one following the patientfor their whole life as they're
struggling with this disease,and so I am the best suited or
my position is the best suitedto really interact with these
patients, not only before andafter the procedure, but during
the procedure too.
I know them the best, I knowwhat they're struggling with.
You know, we examine patientsall the time, and so learning to
(10:20):
do this procedure which I didhave in my fellowships, kind of
where I got my background withthis has been something that I
can offer from both levels, thatI'm not just a random doctor
coming in and out for aprocedure, that I'm holding
their hand before and after,really taking care of them
throughout the whole experience.
And so it's something that Ithink is more comforting to
(10:41):
patients knowing that they havethis doctor not just for a
single point in their lives, butfor their whole life, kind of
their whole journey with tremors.
Speaker 3 (10:47):
Single point in their lives, but for their whole life
, kind of their whole journeywith tremors and as you continue
your relationship with thesepatients, what success stories
are you seeing?
Are your patients coming backweeks later saying this really
changed my life?
Speaker 1 (11:00):
Our first patient is a great example.
So he found it very difficultto impossible to drink coffee,
right Obviously no one wants todo it with a straw and he just
could not pick it up, even withtwo hands, to drink it.
Immediately after the procedure, our project manager came over
with a 20-ounce cup filled tothe brim of steaming hot coffee.
(11:20):
And I was joking.
I was like, can we not startwith water first?
That would probably be better,right?
And the patient just grabbed itand with one hand the hand we
treated just started drinkingthe coffee, and it was the first
time he couldn't even remember,maybe more than a decade since,
he's had coffee.
So it's little things like thatthat really make you emotional
and really happy to see forthese patients who you know it's
(11:43):
life-changing.
I've had another patient who wejust did come out of the
procedure and can't wait to dotheir second side.
So you know, one of the thingswith the procedure is we only
can treat one side of your bodyat that procedure date and then
we can treat the other side ofyour body nine months later.
And so he was already comingout and he was like, sign me up
for nine months, I'm coming backdoing the other side right.
(12:05):
So it's just really exciting tosee you know patients.
A lot of it is.
You know their ability to drinkright and you can imagine going
out to a restaurant, right.
This is patients will tell youthey're like I can't even have,
you know, a glass of champagneor wine without shaking all over
and people are looking at meand it's really embarrassing and
for many patients that's theissue.
Speaker 2 (12:27):
Are there any other potential uses for this
technology beyond what you'vediscovered it works for so far?
Speaker 1 (12:33):
Yeah.
So right now there's about 150clinical trials going on with
this technology throughout thecountry for about 40 or 50
indications that have yet to beapproved by the FDA.
Right now the FDA has approvedto treat essential tremor and
tremors with Parkinson's disease.
In the hopefully soon-to-befuture there's going to be a lot
more applications, not just inthe neurology space but in other
(12:57):
kind of medical specialties,but even in the neurology space
to treat seizures or epilepsy,to treat Alzheimer's, dementia,
addiction which is totally crazyto think about treat bipolar
disorder, treat certain types ofcancers you know we can heat up
those tumors to shrink them orkill them and that different
cancers throughout the body, andso just so many different
(13:20):
indications, some you know.
Again, you would think howcould that even be helpful, like
even treating depression,things like that.
But we've been able to find thatit can be helpful in certain
ways that you deliver theultrasound energy.
So there's actually we're usinghigh intensity ultrasound.
There's actually a lowintensity ultrasound that can be
used on the brain, larger areasof the brain, to break open the
(13:43):
blood brain barrier.
This is kind of a barrier inyour brain that prevents a lot
of toxins and medicines fromreaching the brain.
Well, some of the medicines wewant to get to the brain, like
medicines for Alzheimer's,dementia, for chemotherapy, and
we're just not able to deliverthem effectively because of this
natural barrier.
Well, we can use low levels oflow-intensity ultrasound to
break up that barrier, justtemporarily deliver the medicine
(14:06):
so it actually can work on thebrain, which is kind of an
amazing thing to think about.
Speaker 3 (14:11):
And Justin, you're doing a number of other things
on top of this focusedultrasound.
Tell us about theChristianaCare Movement
Disorders Clinic.
Speaker 1 (14:19):
Yeah, so we actually have a pretty robust team part
of our Movement Disorders Clinic.
It's myself as the director,followed by my partner, dr
Patrick Kearns, who joined us acouple years ago.
We also have a nursepractitioner, sarah Hinkle, and
a physician's assistant, katiePisachensky, focus ultrasound
coordinator, melissa Pacheco allgreat members of the team.
We have a nurse, karen Reed, wehave a social worker, we have a
(14:43):
neuropsychologist.
So we offer a very involvedprocess, a very thorough process
of taking care of our patients.
We offer a lot of differentservices to them.
We do deep brain simulationprogramming, we do botulinum
toxin injections and we seepatients, obviously for any type
of movement disorder.
The more common ones we wouldtalk about essential tremor,
parkinson's, typically are thetwo most common ones that we see
(15:05):
, but we also see dystonia,huntington's disease, ataxia, so
a lot of different types ofdiseases, and we also offer
clinical trials too.
So we have one actively goingon in the Parkinson's space.
We hold annual symposiums forParkinson's disease.
They're usually every April,and so we also engage in
(15:26):
community events.
We do talks to support groups,usually in the Parkinson's space
.
We have quarterly newslettersthat we send out.
We actually just created awebsite for Parkinson's disease.
It's pddeorg orparkinsonsofdelawareorg.
We're just really invested inthe community and the Delaware
(15:46):
region.
We know we want to be here fora long time and really take care
of this aging population whereit just seems that every day
there's more and more patientswith either Parkinson's or
central tremor, because we knowthat those diseases are mostly
caused by environmental factors.
And, growing up in theindustrial age, you're more and
more exposed to those things,which is why we see things like
(16:08):
up in the industrial age, you'remore and more exposed to those
things, which is why we seethings like Parkinson's is 50%
higher of an incidence comparedto 20 years ago.
Same thing with essentialtremor.
Obviously, then, people areliving longer, right, so they
have more time to develop theseconditions as well.
Speaker 2 (16:21):
Justin, thanks so much for talking to us today.
Speaker 1 (16:23):
It was great.
Thank you for having me.
Speaker 3 (16:24):
We'll have more information on the MR-guided
focused ultrasound and movementdisorders, including patient
videos in the show notes forthis me.
We'll have more information onthe MR-guided focused ultrasound
and movement disorders,including patient videos in the
show notes for this episode.
Speaker 2 (16:34):
And don't forget to subscribe to For the Love of
Health on Apple Podcasts orSpotify.
And you can watch the videoversion of For the Love of
Health on Christiana Care'sYouTube channel.
Speaker 3 (16:42):
We'll be back in two weeks with another great
conversation.
Speaker 2 (16:45):
Until then, thanks again for joining us for the
love of health.
It can heat up those cells in order to kill them, to
make them stop causing thetremors.
Speaker 2 (00:09):
You're listening to For the Love of Health, a
podcast about delivering careand creating health, brought to
you by Christiana Care.
And now here are your hosts.
Speaker 3 (00:19):
Hello everyone, I'm Megan McGerman.
Speaker 2 (00:21):
And I'm Jason Tokarski.
Welcome to For the Love ofHealth brought to you by
ChristianaCare.
Speaker 3 (00:25):
Tremor is a neurological condition that
affects approximately 1% of thepopulation overall and 5% of
adults age 60 and over.
It is expected to increasinglyimpact Delawareans as the
state's population ages.
Speaker 2 (00:40):
A new treatment for people suffering from essential
tremor and Parkinson's diseaseis a game changer for
ChristianaCare patients.
Here to tell us more is DrJustin Martello, Director of the
Parkinson's and MovementDisorders Program and the
Focused Ultrasound Program atChristianaCare.
Speaker 3 (00:55):
Justin, thank you so much for your time today.
Speaker 1 (00:57):
Thanks for having me.
Speaker 3 (00:59):
Let's start with definitions.
What is tremor, and how does itdiffer from Parkinson's disease
?
Speaker 1 (01:05):
And a lot of people make that mistake.
Everyone thinks tremors or theshaking of your hands usually
involves your hands, happenseither in old people or in
Parkinson's disease, as youmentioned.
But actually the most commonreason for people having tremor,
or the most common movementdisorder, is actually called
essential tremor.
Don't ask me how they got thename, because people will tell
(01:26):
me there's nothing essentialabout it.
It is something that usuallyhappens later in life, although
younger people can get it too.
It usually involves the hands,as I mentioned, and really when
you're using your hands, sopicking up a cup, usually it's a
very gradually progressiveissue, usually involving both
hands the same, whereas inParkinson's disease, patients
(01:49):
usually get a tremor whenthey're at rest, so they're
resting their hands in theirlaps and then start shaking on
its own.
That's not always the case.
In about a third of Parkinson'spatients don't have tremors,
but that's usually the form oftremor that they have Now, with
essential tremor again over manyyears.
So patients usually in thebeginning just notice a little
bit of shaking Maybe they'reholding the glass or doing their
makeup or brushing their teethand then eventually it starts
getting worse and worse, to thepoint where writing becomes, you
(02:13):
know, impossible.
So signing your name, which westill have to do on like checks
and other important financialpaperwork, so signing things
again, holding a glass withoutneeding two hands or needing a
straw to.
You know it's a lot of littlethings throughout the day and
these things start to build up.
I just had a patient actuallytoday who was lamenting that
(02:34):
trying to put his golf ball onthe tee just couldn't do it, and
you know people are therewaiting for him and he just
could not get it.
So it affects, you know, itstarts building up and quality
of life starts becoming more ofa problem.
Speaker 2 (02:47):
What is the historical treatment for these
tremors?
Speaker 1 (02:51):
Usually we typically start with medications.
Now there aren't that manymedications, so there's really
two first line options.
One is called primidone, theother one's called propranolol.
They're very old medicines,actually first created for other
uses and then repurposed in thetremor world, but now we really
just use them for tremorcontrol.
And then after that there's asecond line agent called
(03:11):
topiramate, and then after thatthere are several, you know,
third and fourth line agents.
But once you get past the firstfew the likelihood that they're
going to be really helpful foryour tremor just goes, you know,
drops off pretty significantly.
That they're going to be reallyhelpful for your tremor just
goes, you know, drops off prettysignificantly.
And so most people get to apoint where either the
medications don't work anymoreor they can't use them because
of other, you know medicaldiseases that they have or other
(03:34):
medications thatcontraindicated you know to use
them both, or they have sideeffects.
And so most of the time theyget to a point where medications
are no longer an option andthey need to look for what we
call more of the proceduraloptions or advanced treatment
options.
Speaker 3 (03:49):
So an advanced treatment option that you're now
doing here at Christiana Careis the MR-guided focused
ultrasound Correct.
Explain to us how that works.
Speaker 1 (03:58):
So we actually know this procedure works because
back in the 60s and 70s wellbefore that we knew that there's
an area in your brain thatcauses the tremors.
You actually have one on eitherside of your brain contributing
to tremors on the opposite sideof your body.
Now, in the 60s and 70s, therewas this procedure where we
would open up your skull, sticka probe down, burn that area to
(04:19):
kill the cells that are causingthe tremors and it would stop
the tremors.
So now we're able to do itwithout all the cutting or
operating on your head, usingultrasound waves.
So ultrasounds normally areharmless, but if we take 1,000
ultrasound waves and they allintersect at one area of your
brain, it can heat up thosecells in order to kill them, to
(04:42):
make them stop causing thetremors.
And we do it in such a fine wayand we use the MRI machine to
really not only locate that areaof your brain that we're
targeting, but also to measurehow much heat we're delivering.
Because that actually is what'shappening.
When all the ultrasound wavesare intersecting at one point it
starts to heat up those cellsand so we can actually measure
(05:02):
the temperature that we'reheating it up in order to
permanently kill the cells andactually that's how we're able
to avoid a lot of the sideeffects is we can deliver low
levels of energy in thebeginning to kind of like stun
the cells.
And then we're constantly goingin and out of the MRI machine
saying like, how do you feel wetreated with a low level of
energy?
(05:22):
And if their tremors start toslow down and they say I had no
side effects, we know we're inthe right spot.
If the tremors are the same andthey're like well, maybe I have
numbness or tingling, okay,we're not in the right area.
We move, no permanent damage isdone.
So we kind of use low levelsand then we crank up the heat in
order to permanently kill thosecells when we know we're in the
right area and it's anoutpatient procedure, so you go
(05:45):
home the same day and there's norehab or medications you need
afterwards.
So it's a very appealing optionfor people who don't want a
more invasive brain surgery.
Speaker 3 (05:55):
It's not an invasive brain surgery, but killing brain
cells still, I'm sure givespeople pause.
So are these brain cells thatyou really don't need?
How does that work?
Speaker 1 (06:06):
Yeah.
So again, it's kind of thetremor center of everyone's
brain.
Everyone has it.
That's why, you see, wheneverpeople are nervous or excited or
fearful, they kind of shake.
It's interesting.
There's some arguments as far aswhy we have this area of our
brain, but we do know thatthat's really all it contributes
to as far as function.
(06:27):
It does not really play a rolein any other kind of physical or
motor function or personalityor memories or anything, and in
fact it's actually far away fromthose things.
Like you know, your thinkingand memory and personality.
And, like I said, we were ableto do this procedure in a much
more invasive way and we knew itwas even safe doing it more
invasively and reallycontributed to just little to no
(06:51):
tremors without causing anyother kind of problems.
Having said that, there areareas around this tremor center
that we want to avoid treating,because we do know that you can
have some side effects rightfrom the procedure.
Everything can have side effects, and so some of them include
numbness and tingling, as Imentioned, usually of your hands
, sometimes of the mouth,balance issues walking in
(07:13):
balance.
So that's the one thing that wecan't really test for while
you're on the MRI machine.
You're just kind of on thetable and so we're not getting
you up and walking you around,and so that is one of the things
that we worry about the most.
Usually it's not significantbalance issues afterwards, but
there is about a 14% chance thatthat could be a permanent kind
of mild worsening of yourbalance and walking, and so
(07:34):
that's the thing that we worryabout the most.
The other things are usuallytemporary and go away weeks to
months after the procedure.
Speaker 2 (07:42):
And, as seems to be the case with a lot of brain
surgeries, you made it soundlike that the patient is awake
through this procedure.
Are you having them do somekinds of tests, aside from just
how do you feel right now in theprocess?
Speaker 1 (07:55):
Yeah, and a lot of people will say, oh, I'm
claustrophobic, I need somethingto calm me down, right, but we
actually don't give you anymedicines.
You're fully awake.
No sedating medicines, becausethat will dampen the tremor.
We want you fully awake,telling us not only how you feel
while we're delivering theultrasound energy, which, by the
way, only takes several seconds, maybe 15 seconds to 20 seconds
(08:16):
at a time, so it's very quick.
We want the tremors at theirworst.
So we even have you come offyour tremor medicines before the
procedure, so you're at yourworst, and then we can see in
real time, as we're deliveringthe energy, the tremor kind of
go away, which is kind ofamazing when you think about it.
We have them draw spiralsthroughout the procedure to kind
of test their tremors.
We have them do otheractivities, sometimes like
(08:38):
pretending to drink from abottle and really bring out the
tremor, Because some people willsay my tremors really come out
with this sort of action or thissort of activity.
So we try and mimic how badtheir tremor is at their worst
so we can see in real time howthey improve.
And so we're constantly goingin and out of the MRI machines,
doing the spirals, doinghandwriting samples to really
(08:59):
see that effect.
Speaker 2 (09:00):
Christiana Care is the first health center in
Delaware to provide thisprocedure.
There are others in the nationwho are doing it, but what
really is setting ChristianaCare's offering of this
procedure apart from others?
Speaker 1 (09:13):
So we are the only center in the whole country
where the procedure is run bythe neurologist or by the
movement disorder specialist ormyself.
Usually it's done by aneurosurgeon, specifically a
functional neurosurgeon, butthere are centers that use
neuroradiologists.
There's actually two others whouse neuroradiologists, but
neurologists have been involvedin the procedure in other
(09:34):
centers, but at Christiana CareI'm the one running the whole
show without the role of afunctional neurosurgeon being
involved, and so that is unique,not only in the setting of not
having a functional neurosurgeoninvolved, but also with
neurosurgeons.
They don't follow patients overtime, right, yeah, they'll have
some pre-op appointments andpost-op appointments, but I'm
(09:58):
the one following the patientfor their whole life as they're
struggling with this disease,and so I am the best suited or
my position is the best suitedto really interact with these
patients, not only before andafter the procedure, but during
the procedure too.
I know them the best, I knowwhat they're struggling with.
You know, we examine patientsall the time, and so learning to
(10:20):
do this procedure which I didhave in my fellowships, kind of
where I got my background withthis has been something that I
can offer from both levels, thatI'm not just a random doctor
coming in and out for aprocedure, that I'm holding
their hand before and after,really taking care of them
throughout the whole experience.
And so it's something that Ithink is more comforting to
(10:41):
patients knowing that they havethis doctor not just for a
single point in their lives, butfor their whole life, kind of
their whole journey with tremors.
Speaker 3 (10:47):
Single point in their lives, but for their whole life
, kind of their whole journeywith tremors and as you continue
your relationship with thesepatients, what success stories
are you seeing?
Are your patients coming backweeks later saying this really
changed my life?
Speaker 1 (11:00):
Our first patient is a great example.
So he found it very difficultto impossible to drink coffee,
right Obviously no one wants todo it with a straw and he just
could not pick it up, even withtwo hands, to drink it.
Immediately after the procedure, our project manager came over
with a 20-ounce cup filled tothe brim of steaming hot coffee.
(11:20):
And I was joking.
I was like, can we not startwith water first?
That would probably be better,right?
And the patient just grabbed itand with one hand the hand we
treated just started drinkingthe coffee, and it was the first
time he couldn't even remember,maybe more than a decade since,
he's had coffee.
So it's little things like thatthat really make you emotional
and really happy to see forthese patients who you know it's
(11:43):
life-changing.
I've had another patient who wejust did come out of the
procedure and can't wait to dotheir second side.
So you know, one of the thingswith the procedure is we only
can treat one side of your bodyat that procedure date and then
we can treat the other side ofyour body nine months later.
And so he was already comingout and he was like, sign me up
for nine months, I'm coming backdoing the other side right.
(12:05):
So it's just really exciting tosee you know patients.
A lot of it is.
You know their ability to drinkright and you can imagine going
out to a restaurant, right.
This is patients will tell youthey're like I can't even have,
you know, a glass of champagneor wine without shaking all over
and people are looking at meand it's really embarrassing and
for many patients that's theissue.
Speaker 2 (12:27):
Are there any other potential uses for this
technology beyond what you'vediscovered it works for so far?
Speaker 1 (12:33):
Yeah.
So right now there's about 150clinical trials going on with
this technology throughout thecountry for about 40 or 50
indications that have yet to beapproved by the FDA.
Right now the FDA has approvedto treat essential tremor and
tremors with Parkinson's disease.
In the hopefully soon-to-befuture there's going to be a lot
more applications, not just inthe neurology space but in other
(12:57):
kind of medical specialties,but even in the neurology space
to treat seizures or epilepsy,to treat Alzheimer's, dementia,
addiction which is totally crazyto think about treat bipolar
disorder, treat certain types ofcancers you know we can heat up
those tumors to shrink them orkill them and that different
cancers throughout the body, andso just so many different
(13:20):
indications, some you know.
Again, you would think howcould that even be helpful, like
even treating depression,things like that.
But we've been able to find thatit can be helpful in certain
ways that you deliver theultrasound energy.
So there's actually we're usinghigh intensity ultrasound.
There's actually a lowintensity ultrasound that can be
used on the brain, larger areasof the brain, to break open the
(13:43):
blood brain barrier.
This is kind of a barrier inyour brain that prevents a lot
of toxins and medicines fromreaching the brain.
Well, some of the medicines wewant to get to the brain, like
medicines for Alzheimer's,dementia, for chemotherapy, and
we're just not able to deliverthem effectively because of this
natural barrier.
Well, we can use low levels oflow-intensity ultrasound to
break up that barrier, justtemporarily deliver the medicine
(14:06):
so it actually can work on thebrain, which is kind of an
amazing thing to think about.
Speaker 3 (14:11):
And Justin, you're doing a number of other things
on top of this focusedultrasound.
Tell us about theChristianaCare Movement
Disorders Clinic.
Speaker 1 (14:19):
Yeah, so we actually have a pretty robust team part
of our Movement Disorders Clinic.
It's myself as the director,followed by my partner, dr
Patrick Kearns, who joined us acouple years ago.
We also have a nursepractitioner, sarah Hinkle, and
a physician's assistant, katiePisachensky, focus ultrasound
coordinator, melissa Pacheco allgreat members of the team.
We have a nurse, karen Reed, wehave a social worker, we have a
(14:43):
neuropsychologist.
So we offer a very involvedprocess, a very thorough process
of taking care of our patients.
We offer a lot of differentservices to them.
We do deep brain simulationprogramming, we do botulinum
toxin injections and we seepatients, obviously for any type
of movement disorder.
The more common ones we wouldtalk about essential tremor,
parkinson's, typically are thetwo most common ones that we see
(15:05):
, but we also see dystonia,huntington's disease, ataxia, so
a lot of different types ofdiseases, and we also offer
clinical trials too.
So we have one actively goingon in the Parkinson's space.
We hold annual symposiums forParkinson's disease.
They're usually every April,and so we also engage in
(15:26):
community events.
We do talks to support groups,usually in the Parkinson's space
.
We have quarterly newslettersthat we send out.
We actually just created awebsite for Parkinson's disease.
It's pddeorg orparkinsonsofdelawareorg.
We're just really invested inthe community and the Delaware
(15:46):
region.
We know we want to be here fora long time and really take care
of this aging population whereit just seems that every day
there's more and more patientswith either Parkinson's or
central tremor, because we knowthat those diseases are mostly
caused by environmental factors.
And, growing up in theindustrial age, you're more and
more exposed to those things,which is why we see things like
(16:08):
up in the industrial age, you'remore and more exposed to those
things, which is why we seethings like Parkinson's is 50%
higher of an incidence comparedto 20 years ago.
Same thing with essentialtremor.
Obviously, then, people areliving longer, right, so they
have more time to develop theseconditions as well.
Speaker 2 (16:21):
Justin, thanks so much for talking to us today.
Speaker 1 (16:23):
It was great.
Thank you for having me.
Speaker 3 (16:24):
We'll have more information on the MR-guided
focused ultrasound and movementdisorders, including patient
videos in the show notes forthis me.
We'll have more information onthe MR-guided focused ultrasound
and movement disorders,including patient videos in the
show notes for this episode.
Speaker 2 (16:34):
And don't forget to subscribe to For the Love of
Health on Apple Podcasts orSpotify.
And you can watch the videoversion of For the Love of
Health on Christiana Care'sYouTube channel.
Speaker 3 (16:42):
We'll be back in two weeks with another great
conversation.
Speaker 2 (16:45):
Until then, thanks again for joining us for the
love of health.
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