Sept. 7,2015
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Baltimore, MD-- September 2, 2015--Kimberly Spletter of Frederick, left, has a follow-up appointment with neurologist Dr. Paul Fishman, right, at the University of Maryland Medical Center. She recently had a new treatment for Parkinson's disease called "MRI-guided focused ultrasound."
| (Barbara Haddock Taylor / Baltimore Sun) caption |
Kimberly Spletter's knee would pop backward involuntarily, or
her leg would shake uncontrollably. Sometimes she'd cross her legs tightly,
trying to make it all stop — to no avail.
"I had to live with it," said the 50-year-old
Frederick woman, who suffers from Parkinson's disease. "I tried to keep it
to a dull roar, but that was the best that I could do."
That all changed in a matter of hours last week after Spletter
underwent a groundbreaking procedure at the University of Maryland Medical
Center that guided ultrasound waves through her skull to kill the brain cells
interfering with her motor skills. She's participating in a clinical study
looking at a cutting-edge way — known as focused ultrasound — to possibly treat
certain Parkinson's symptoms non invasively.
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| Device developed at Hopkins could help Parkinson's disease symptoms |
As many as 1 million people in the United States live with
Parkinson's, a nervous system disorder that affects movement and becomes
progressively worse over time. The disease most often afflicts older people,
but about 4 percent of those suffering from it are under age 50. Symptoms
include tremors, stiff limbs, trouble balancing and a general slowdown in
movement. Medications can ease the symptoms but may trigger other side effects
in patients.
Spletter was the first participant at the University of Maryland
Medical Center to participate in the study, which also is being conducted in
Korea, Canada and at the University of Virginia.
Spletter said many of her painful symptoms have subsided, and
she is looking forward to evening walks in downtown Frederick as her condition
continues to improve.
"I feel like a got a new lease on life," she said.
"My quality of life has improved so much."
The question is for how long.
Scientists already know that targeting specific cells in the
brain can minimize Parkinson's symptoms. But current treatments involve more
aggressive tactics than the procedure doctors performed on Spletter.
The more common method is to cut a hole into a patient's head
and put electrodes on a specific part of the brain. A stimulator implanted
under the skin of a patient's collar bone transmits small electrical pulses to
block symptoms.
Doctors also can use radiation to destroy cells or insert a
needle through the head and use radio frequency waves to heat the cells to
destroy them.
There were no cuts made to Spletter's skull as part of her
procedure. The most she felt was intense pressure from a metal frame and helmet
tightened around her head to prevent it from moving.
Ultrasonic waves were directed through Spletter's skull, much
like a magnifying glass aims sunlight at a certain spot. The waves provide
energy that is low enough that they don't damage the brain as they pass
through, but, where they meet at single point, the energy adds up, creating
enough heat to kill the cells.
The procedure was done as Spletter lay in a MRI machine so
doctors could watch what was happening. They would stop from time to time to
see if she was having vision problems or other side affects that might signal
they weren't targeting the correct part of the brain.
Once they had a target, doctors asked Spletter to perform
certain exercises, such as touching her thumb to her finger or pretending to
press a gas pedal with her foot, to see if the surgery was working.
"The effects are immediate," said Dr. Paul Fishman, a
professor of neurology at the University of Maryland School of Medicine, who
has treated Spletter for several years and recommended she
participate in the trial. "We saw improvement in her
Parkinson's while doing her procedure."
Spletter could not believe what was happening.
"It was a miracle," she said.
The procedure performed on Spletter is one of many in the
rapidly growing medical field of focused ultrasound. When the Focused
Ultrasound Foundation was founded nine years ago, the therapy was being looked
at to treat three conditions. Today, there are more than 58 ways the treatment
is being used in various stages of research, development and commercialization.
It has been used to treat fibroid tumors, brain tumors and
obsessive-compulsive disorder. There are plans for a clinical trial to see it
could be used to treat Alzheimer's disease. The Parkinson's study builds off a
previous pilot trial that looked at focused ultrasound to treat essential
tremor, another progressive movement disorder.
"This is just one arrow in the quiver that neurosurgeons
will have, if it works, to treat Parkinson's disease," said Dr. Neal F.
Kassell, founder and chairman of the Focused Ultrasound Foundation, which is
funding part of the study, and a professor of neurosurgery at the University of
Virginia.
Kassell and the University of Maryland researchers caution that
more research is needed to determine how effective the treatment is in treating
Parkinson's. The study Spletter participated in will ultimately include 40
patients, who will be followed for a year.
"One of the things we don't know is whether this is
durable," said Dr. Howard M. Eisenberg, principal investigator and the
Raymond K. Thompson Chair of Neurosurgery at the University of Maryland School
of Medicine. Spletter "was good today. She was seen a few days ago, and
she was good. We don't know if she'll be good in six months."
A larger study will need to be done eventually.
"It is in its early stages," Kassell said. "It
remains to be proven definitively in a rigorous scientific trial whether it
provides true value in terms of improving outcomes and reducing costs."
The study also is limited in scope. For instance, researchers
are looking only at subjects with symptoms on one side of their bodies.
Parkinson's only affects the left side of Spletter's body. Participants also
must have had a negative reaction to levodopa, a drug used to treat Parkinson's
that sometimes leads to a poor quality of life.
Spletter was nervous about participating in the trial at first.
"There wasn't enough information out there about it,"
she said. "If I had been the 5,000th patient, I would be pretty calm about
it. But fear of the unknown kept bothering me."
But Spletter's condition had become so bad that she was hoping
for any relief. She couldn't walk anywhere and was almost always in pain. At
restaurants, she sat on the inside of booths so people wouldn't stare at her
trembling leg.
She knows there is a chance the effects of the procedure might
not last long. For now, she is enjoying her new life — and looking forward to
those downtown walks.
"It doesn't seem like a big deal," she said. "But
when you can't do it, it is."
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