Focused Ultrasound in Parkinson’s: A Conversation With Arjun Desai, MD

Last November, the U.S. Food and Drug Administration approved Exablate Neuro to treat motor symptoms in Parkinson’s disease patients, as reported by Parkinson’s News Today‘s Patricia Inacio, PhD. Created by medical device company Insightec, Exablate Neuro is a magnetic resonance, image-guided, focused ultrasound (MRgFUS) system that can treat tremors noninvasively.

As clinical trials continue, the technology is gaining momentum. I was fortunate to be introduced to Arjun Desai, MD, the chief strategic innovation officer at Insightec. He talked with me via Zoom about the technology and answered some questions I have as a patient with Parkinson’s disease.

Excerpts of our conversation follow, with light editing for clarity.

LD: Thank you for allowing our mutual friend to introduce us and for agreeing to answer some questions. Most patients are familiar with deep brain stimulation (DBS) as a Parkinson’s treatment, but what is MRgFUS?

AD: MRgFUS is an incision-less therapeutic treatment, which uses MRI-guided ultrasound waves to precisely target and treat areas deep inside the brain that cause movement problems.

It sounds straightforward. However, the brain presents challenges due to the skull scattering the sound waves. By using advanced ultrasound technology in combination with real-time MRI images, we are able to refocus the energy beyond the skull and into the brain. During the treatment, we use the MRI along with an alert patient to test brain areas for accuracy by delivering a test dose, which if correct will temporarily fix the disorder. With this clinical confirmation, the full therapeutic dose is delivered, where the energy precisely creates heat to form a permanent lesion at the targeted brain area.

The treatment is irreversible and currently offered as a unilateral treatment, meaning only one side of the brain is treated. However, there is ongoing research to assess whether a bilateral approach demonstrates appropriate safety and efficacy. This would be a staged process and based on a case-by-case basis of patient symptoms.

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Is it a relatively new treatment in the United States?

While the technology of focused ultrasound is relatively new in the United States, the company, Insightec, is [more than] 20 years old. Over the last five to seven years, Insightec has advanced technology to treat the brain and has been conducting clinical research to approve treatments for movement disorders globally. As a result of compelling multiyear clinical evidence and multiple FDA approvals, the technology has gained wide Medicare and private reimbursement coverage. It is also becoming part of training programs for neurosurgeons, where many top DBS surgeons and institutions also perform the Exablate treatment.

The FDA approval in 2016 and the successful treatment of essential tremor have driven the adoption of the technology. It has received two FDA approvals as a treatment option for Parkinson’s. In 2018, it gained approval as a treatment for tremor-dominant Parkinson’s for patients that do not respond to medications. In 2021, the approval expanded to include other nonresponder symptoms, including bradykinesia, rigidity, and dyskinesia. The Exablate Neuro treatment is now being offered at more than 100 centers worldwide, including the University of Maryland Medical Center, locally.

I have young-onset Parkinson’s, and choosing one side of the brain to treat is not an option for me at this point. What progression level is your demographic?

While research investigators are looking at how this technology may alter progression in the early stages of Parkinson’s, MRgFUS is mainly an addition to the spectrum of care for advanced symptoms of Parkinson’s.

It is beneficial for those who cannot tolerate DBS or want a noninvasive option. It has also gained traction during COVID because it does not require a hospital stay.

Not everyone is informed about focused ultrasound. How are patients learning about it?

The technology has great momentum with patients, especially those with essential tremor. The Parkinson’s community is well organized, and educating those within the [movement disorder] community that this lesioning technology has evidence to support it is important.

Thank you. One last question: If you had to share one quote about MRgFUS, what would it be?

Our ability to help people get better, live the lives they want to for longer, and in the way and fashion they want to is only getting better through science and technology. Focused ultrasound is a great example of that. Reaching out and challenging the opportunities for yourself and your loved ones is important. Ask about these therapies and make sure your neurologists, neurosurgeons, and caregivers understand what the best opportunities are for you. Think of focused ultrasound as one element of the journey to wellness — certainly, one that we are very happy to bring to Parkinson’s patients and their families.

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Treatment plans are collaborative. It is clear that Desai is an advocate for patients understanding available treatment options as they continue to emerge. With education, we can advocate for ourselves and be part of the plan.

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, Bionews, and are intended to spark discussion about issues pertaining to Parkinson’s disease.