Physician Update

UTSW First in Texas to Offer HIFU for Noninvasive Treatment of Brain Disease

Jimmy Hiner was the first patient in Texas to receive HIFU to treat an essential tremor.

Imagine if you had a patient who had been dealing with a tremor for decades, and you were able to offer them an outpatient procedure – without anesthesia, incisions, or implantable hardware – that could take care of that tremor in less than an hour.

We had just that scenario earlier this year, and the results were, in the patient’s own words, “amazing ... like flipping a switch.”

The innovative procedure is called MR-guided high-intensity focused ultrasound, or MRgHIFU, which uses MRI-guided focused ultrasound waves to treat neurological and even psychiatric diseases across an intact skull. HIFU is also used to treat prostate cancer.

One of two centers in the country

UT Southwestern is the only center in the country using four tract-based tractography. To do this, an advanced MRI is performed to map the patient’s brain showing us the target and the areas to avoid. Then with real-time MR guidance we ablate this target with high-intensity focused ultrasound (HIFU). The ultrasound waves interrupt brain pathways that conduct the signal that causes the tremors. The four-tract method is highly precise and highly personalized.

That said, while transcranial MRI-guided HIFU offers us another valuable tool to help patients with tremors, that does not mean it’s the answer for every patient. We take extensive measures to determine the optimal approach for each individual, whether that be changes to medications, deep brain stimulation, or HIFU.

“I have clinical trials underway that will hopefully expand the technology’s use to deliver therapies to targeted parts of the brain in patients with neurodegenerative diseases such as Alzheimer’s disease as well as brain tumors.”

Bhavya R. Shah, M.D.

UTSW’s neuromodulation network

If you have a patient with a tremor who is interested in MRgHIFU, he or she will first be evaluated by a neurologist specializing in movement disorders.

The evaluation includes a complete medical history and physical. There are many potential causes of tremor, so the first step is accurate diagnosis. We then review all options for bringing the tremor under control, including pharmacological therapy, brain surgical treatments, and transcranial MRI-guided focused ultrasound.

Patients who are possible candidates for either deep brain stimulation surgery or transcranial MR-guided focused ultrasound are enrolled in UTSW’s neuromodulation network. The network organizes a series of tests, including measurement of tremor severity using validated scales and videotape analysis, cognitive testing, and other tests as needed.

After the testing, we hold a multidisciplinary conference with neurologists, neurosurgeons, neuroradiologists, neuropsychologists, and physical therapists to review each patient’s case. We recommend the best option for the patient, considering the risks and benefits of each approach and the patient’s preference. If transcranial MRI-guided focused ultrasound is recommended, patients then meet with my team.

Game-changing technology

Currently, the Food and Drug Administration has approved use of transcranial MR-guided HIFU to treat essential tremor and tremor-dominant Parkinson’s disease. I have clinical trials underway that will hopefully expand the technology’s use to deliver therapies to targeted parts of the brain in patients with neurodegenerative diseases such as Alzheimer’s disease as well as brain tumors. I also anticipate using the technique to deliver immunotherapy and gene therapies in patients with neurodegenerative diseases, movement disorders, and genetic diseases.

In short, we feel this technology’s impact on the way physicians treat brain diseases will be seismic.

About the Author

Bhavya R. Shah, M.D., is an Assistant Professor of Radiology and Neurosurgery at UT Southwestern, an Assistant Professor in the Division of Neuroradiology at UTSW’s Peter O’Donnell Jr. Brain Institute, Director of the Neuro Focused Ultrasound Program, and Co-Director of the UTSW Focused Ultrasound Lab. An expert in advanced imaging techniques, image-guided procedures, and MRI-guided HIFU, his primary research interests include transcranial focused ultrasound (FUS) for the treatment of Alzheimer’s and brain tumors, nerve stimulation to improve limb function after stroke, and biomedical device innovation.

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To consult with Dr. Shah or to refer a patient, call 214-645-0983.

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