Focused Ultrasound: A Non-Invasive Revolution in Neurological Treatment
Milan, Italy – A modern frontier in neurological treatment is unfolding at the Besta Neurological Institute in Milan, with the implementation of cutting-edge focused ultrasound technology. This innovative approach offers a non-invasive alternative to traditional methods for managing conditions like essential tremor and potentially, in the future, Parkinson’s disease, Alzheimer’s and other neurological disorders.
How Focused Ultrasound Works
Focused ultrasound utilizes high-frequency sound waves to precisely target specific areas within the brain. The procedure, guided by Magnetic Resonance Imaging (MRI), allows for two primary applications: ablation of problematic brain tissue or increasing the permeability of blood vessels to deliver targeted drug therapies. The choice between high and low-frequency ultrasound depends on the treatment goal.
High-Frequency Ultrasound: Ablation for Tremors
For conditions like essential tremor, high-frequency focused ultrasound offers a compelling alternative to deep brain stimulation (DBS). DBS requires invasive surgery to implant electrodes, although focused ultrasound is entirely non-invasive. Patients remain awake during the procedure, which takes place within an MRI machine. The MRI directs the ultrasound waves with extreme precision to the targeted nerve cells. As the tissue reaches a temperature of 45 degrees Celsius, the effect is reversible. If tremor reduction is achieved, the temperature is increased to 55 degrees Celsius, resulting in permanent ablation of the targeted area.
Low-Frequency Ultrasound: Enhancing Drug Delivery
Low-frequency ultrasound is employed to temporarily widen the junctions between cells in the cerebral blood vessels. This allows drugs that normally cannot cross the blood-brain barrier to reach tumors or other diseased tissues. At the Besta Institute, this technique has been experimentally used to treat 24 glioblastoma cases.
The Exablate Technology
The Besta Neurological Institute initially adopted the Exablate Neuro system in 2019, a donation from the Ravelli Foundation. The Lombardy Region has now equipped the institute with the latest generation, Exablate Prime, reducing procedure times from approximately 3.5 hours to 2 hours. According to Francesco DiMeco, Director of the Department of Neurosurgery at the Besta Institute and Full Professor of Neurosurgery at the University of Milan, only five Exablate Prime systems are currently in operation in Europe.
Current and Future Applications
Beyond essential tremor, focused ultrasound is being explored for the treatment of tremor caused by Parkinson’s disease and neuropathic pain. Researchers are also investigating potential applications for Huntington’s chorea, Alzheimer’s disease (to facilitate antibody delivery against amyloid plaque), obsessive-compulsive disorders, and resistant depression.
Accessibility and the Future of Focused Ultrasound
The treatment is now covered by the Italian National Health Service in the Lombardy Region. With the new Exablate Prime technology, the Besta Institute aims to treat at least 130-150 patients annually. To address the growing demand and waiting lists, the institute is exploring public-private partnerships to potentially acquire a second device. Professor DiMeco emphasizes that treatment is reserved for patients with a clear indication and is determined by a multidisciplinary team including neurologists, neurosurgeons, neuroradiologists, and medical physicists.