I recently spoke with Andrew – an INSIGHTEC Clinical Account Manager (CAM) – about the flow of an essential tremor treatment day through his eyes. An INSIGHTEC Clinical Account Manager (CAM) helps Treatment Centers offering focused ultrasound run an effective and efficient service line.
His responses will give you an on-the-ground look at MRgFUS treatment of a patient with medication-refractory essential tremor from someone present throughout the day. Please note that each treatment center has its own processes and procedures for treatment, and Andrew’s description serves as an example. Each patient’s care is determined by the treating physician.
Can you take me through the timeline of a typical treatment day for a medication-refractory essential tremor patient?
Well, to begin with – even before the treatment day – every patient will meet with a physician and neurologist to discuss treatment options and have a CT scan. Every patient should decide for themselves, together with a physician, which treatment is right for them.
Then moving to the actual treatment day, the patient will generally arrive at the MRI department at around 7AM (although this may differ depending on the Treatment Center) where they’ll fill out a registration form which includes biographical information (name, gender, etc.), medical history, and any allergies, to name a few.
About an hour after arriving, “prep”, short for preparation, begins in the MRI prep room. First the patient’s head will be cleanly shaven. This is necessary so that the focused ultrasound waves have a clear path through the skull and to minimize the chances of getting a scalp burn. The clinical team will take baseline tremor scores, secure the stereotactic frame to hold the patient’s head in place, and apply the silicon membrane to their head (it is basically like a “swim cap”).
The prep phase will generally take about one hour. From there, the patient moves to the MRI room – just through the door from the prep room. The patient lies flat on the MRI table, which will move in and out of the MRI scanner during treatment. For comfort, the patient will be provided with pillows under their legs, as their head rests in the helmet, where cool water will circulate.
With the patient settled comfortably into the MRI, and the treating team (and sometimes an INSIGHTEC CAM and Clinical Applications Specialist) in the adjoining Control room, the treatment begins. First, low energy is applied – each application of energy is referred to as a sonication. After each sonication, the treating team goes into the MRI room and performs neurological tremor tests. This is to evaluate the tremor improvement, which at this point is temporary, and to identify any potential side effects. The neurosurgeon will then apply high energy sonications to create a small lesion. For many patients, this results in immediate tremor improvement.
From there, the patient is escorted to a recovery room where they’ll relax before going home. It is up to the clinical discretion of the treating physician when the patient returns home.
How do patients seem when they arrive on a treatment day? During? Afterwards?
When they arrive, some patients are nervous. The entire treatment team explains what is going on in order to help the patients relax before, during and after the treatment.
After the treatment, patients, simply put, are happy. Some patients are able to drink a cup of water with their treated hand for the first time in a long time. One patient shared that she couldn’t wait to show off her knife and fork skills at Thanksgiving dinner.
Disclaimer: The patient experiences described in this post may not represent all patient experiences and outcomes. For safety information, click here.