Nursing Management of the Patient Undergoing Focused Ultrasound: A New Treatment Option for Essential Tremor

Abstract

Essential tremor (ET) is among the most common neurological movement disorders that causes postural or action tremors, with an estimated prevalence nationwide of less than 3% of the population. The incidence of ET increases with age but often affects younger adults and has a familial trait association. Depending on disease progression, ET can cause significant limitations for individuals, in many cases, significantly limiting their ability to perform activities of daily living and occupational responsibilities. Until recently, treatment of ET heavily relied on medication management and invasive surgery, such as deep brain stimulation. With advances in the use of focused ultrasound (FUS) for treatment of various medical conditions, recent clinical trials have revealed positive outcomes with the use of FUS as a less invasive approach to treat patients with medication-refractory ET. In a large academic medical center in the mid-Atlantic region, the Department of Neurosurgery conducted a continued access study, recently approved by the Food and Drug Administration, to evaluate the effectiveness of transcranial FUS thalamotomy for the treatment of medication-refractory ET. One patient's experience will be introduced, including discussion of evidence-based treatment options for ET and information on the nursing management of the patient undergoing FUS thalamotomy.

In vitrosingle-unit recordings reveal increased peripheral nerve conduction velocity by focused pulsed ultrasound

“…The promise of therapeutic ultrasound (US) in medical applications has been marked by numerous research activities for ages and rejuvenated as an emerging modality for treating neurologic disorders like essential tremor [28], depression [29], obsessivecompulsive disorder [30], dystonia [31], epilepsy, Parkinson's-, Alzheimer's-disease alongside multifarious neuropathic pains [32,33]. Though detailed guidelines for US stimulation are yet to be published, in preliminary level, FDA has approved the application of therapeutic US allowing a maximum intensity of (0.72 W/cm 2 I SPTA ) [20].…”

“…To assess the effects of US stimulation on individual sciatic nerve axon, we employed an electrical stimulus protocol that evokes action potentials at the proximal end of the sciatic nerve. The protocol consists of 90 consecutive electrical pulses at 0.5 Hz, which were divided as pre-US stimulation pulses (1-20), during US stimulation pulses (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) and post-US stimulation pulses (41-90). For each 90-pulse protocol, the US stimulation intensity remained the same.…”

Technical Principles and Clinical Workflow of Transcranial MR-Guided Focused Ultrasound

“…This limitation will have implication on the feasibility of bilateral procedures conducted in a single session. In recent years, there has also been an increased engagement of the entire health care team in understanding the unique implications of this novel technology [49, 79].…”