A Pilot Trial: MRI-guided Focused Ultrasound for Refractory Tremor in Multiple Sclerosis

Summary: Almost 60% of people living with MS are affected by tremor or shakiness. Of those individuals, between 3-15% have moderate to severe disability related to tremor. Tremor can affect quality of life. Drugs are most commonly used in the management of MS tremor, but with limited success and potential side effects. A number of neurosurgical techniques have been developed to treat tremor although to-date, none of these techniques have proved safe and effective in the long-term. This team proposes to use an innovative technique, MRI-guided focused ultrasound, to treat tremor in people with MS in a pilot trial.

Project Description: This team has developed an innovative treatment for tremor that uses MRI-guided focused ultrasound (termed MRIgFUS) to perform incisionless thalamotomies under MRI guidance. The focused ultrasound creates small brain lesions using sound energy travelling across the intact skull (i.e. no need for drilling holes in the skull). When paired with MRI, more than 1,000 ultrasound beams can be focused precisely on the tremor-generating target. The energy of the ultrasound beams can be used to destroy the neurons in the tremor network, thus dampening the tremor. This research will use a single-centre, single-arm, open-label pilot trial to establish the feasibility (i.e. can people with MS tolerate the procedure), the preliminary safety (i.e. rate of adverse events) and the efficacy of this technique (i.e. reduces tremor severity) in people with MS. This would be the first study to use the focused ultrasound technology in people with MS.

Potential Impact: The success of this trial will provide the preliminary data required to conduct a larger trial to demonstrate the efficacy for the treatment of MS. If this technique can successfully decrease tremor-related disability in people with MS, it would improve patients’ quality of life.

Project Status: In progress